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Bergin SP, Chemaly RF, Dadwal SS, Hill JA, Lee YJ, Haidar G, Luk A, Drelick A, Chin-Hong PV, Benamu E, Khawaja F, Nanayakkara D, Papanicolaou GA, Small CB, Fung M, Barron MA, Davis T, McClain MT, Maziarz EK, Madut DB, Bedoya AD, Gilstrap DL, Todd JL, Barkauskas CE, Bigelow R, Leimberger JD, Tsalik EL, Wolf O, Mughar M, Hollemon D, Duttagupta R, Lupu DS, Bercovici S, Perkins BA, Blauwkamp TA, Fowler VG, Holland TL. Plasma Microbial Cell-Free DNA Sequencing in Immunocompromised Patients With Pneumonia: A Prospective Observational Study. Clin Infect Dis 2024; 78:775-784. [PMID: 37815489 PMCID: PMC10954333 DOI: 10.1093/cid/ciad599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Pneumonia is a common cause of morbidity and mortality, yet a causative pathogen is identified in a minority of cases. Plasma microbial cell-free DNA sequencing may improve diagnostic yield in immunocompromised patients with pneumonia. METHODS In this prospective, multicenter, observational study of immunocompromised adults undergoing bronchoscopy to establish a pneumonia etiology, plasma microbial cell-free DNA sequencing was compared to standardized usual care testing. Pneumonia etiology was adjudicated by a blinded independent committee. The primary outcome, additive diagnostic value, was assessed in the Per Protocol population (patients with complete testing results and no major protocol deviations) and defined as the percent of patients with an etiology of pneumonia exclusively identified by plasma microbial cell-free DNA sequencing. Clinical additive diagnostic value was assessed in the Per Protocol subgroup with negative usual care testing. RESULTS Of 257 patients, 173 met Per Protocol criteria. A pneumonia etiology was identified by usual care in 52/173 (30.1%), plasma microbial cell-free DNA sequencing in 49/173 (28.3%) and the combination of both in 73/173 (42.2%) patients. Plasma microbial cell-free DNA sequencing exclusively identified an etiology of pneumonia in 21/173 patients (additive diagnostic value 12.1%, 95% confidence interval [CI], 7.7% to 18.0%, P < .001). In the Per Protocol subgroup with negative usual care testing, plasma microbial cell-free DNA sequencing identified a pneumonia etiology in 21/121 patients (clinical additive diagnostic value 17.4%, 95% CI, 11.1% to 25.3%). CONCLUSIONS Non-invasive plasma microbial cell-free DNA sequencing significantly increased diagnostic yield in immunocompromised patients with pneumonia undergoing bronchoscopy and extensive microbiologic and molecular testing. CLINICAL TRIALS REGISTRATION NCT04047719.
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Affiliation(s)
- Stephen P Bergin
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjeet S Dadwal
- Department of Medicine, Division of Infectious Diseases, City of Hope National Medical Center, Duarte California, California, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yeon Joo Lee
- Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, NewYork, New York, USA
- Department of Medicine, Weill Cornell Medicine, NewYork, New York, USA
| | - Ghady Haidar
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alfred Luk
- Section of Infectious Diseases, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Alexander Drelick
- Department of Medicine, Weill Cornell Medicine, NewYork, New York, USA
- Department of Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Peter V Chin-Hong
- Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA
| | - Esther Benamu
- Division of Infectious Diseases, University of Colorado, Aurora, Colorado, USA
| | - Fareed Khawaja
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Deepa Nanayakkara
- Department of Medicine, Division of Infectious Diseases, City of Hope National Medical Center, Duarte California, California, USA
| | - Genovefa A Papanicolaou
- Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, NewYork, New York, USA
- Department of Medicine, Weill Cornell Medicine, NewYork, New York, USA
| | - Catherine Butkus Small
- Department of Medicine, Weill Cornell Medicine, NewYork, New York, USA
- Department of Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Monica Fung
- Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA
| | - Michelle A Barron
- Division of Infectious Diseases, University of Colorado, Aurora, Colorado, USA
| | - Thomas Davis
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Micah T McClain
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eileen K Maziarz
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Deng B Madut
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Armando D Bedoya
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel L Gilstrap
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jamie L Todd
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Christina E Barkauskas
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robert Bigelow
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Ephraim L Tsalik
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Emergency Medicine Services, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- VP and Chief Scientific Officer, Infectious Disease, Danaher Diagnostics, Washington, DC, USA
| | - Olivia Wolf
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | - Vance G Fowler
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomas L Holland
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
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Dickter JK, Aribi A, Cardoso AA, Gianella S, Gendzekhadze K, Li S, Feng Y, Chaillon A, Laird GM, Browning DL, Ross JA, Nanayakkara DD, Puing A, Stan R, Lai LL, Chang S, Kidambi TD, Thomas S, Al Malki MM, Nakamura R, Alvarnas J, Taplitz RA, Dadwal SS, Forman SJ, Zaia JA. HIV-1 Remission after Allogeneic Hematopoietic-Cell Transplantation. N Engl J Med 2024; 390:669-671. [PMID: 38354149 PMCID: PMC10906479 DOI: 10.1056/nejmc2312556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
| | - Ahmed Aribi
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | - Shirley Li
- City of Hope National Medical Center, Duarte, CA
| | - Ye Feng
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | | | | | - Rodica Stan
- City of Hope National Medical Center, Duarte, CA
| | - Lily L Lai
- City of Hope National Medical Center, Duarte, CA
| | - Sue Chang
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | - Ryo Nakamura
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | - John A Zaia
- City of Hope National Medical Center, Duarte, CA
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Russo D, Schmitt M, Pilorge S, Stelljes M, Kawakita T, Teal VL, Haber B, Bopp C, Dadwal SS, Badshah C. Efficacy and safety of extended duration letermovir prophylaxis in recipients of haematopoietic stem-cell transplantation at risk of cytomegalovirus infection: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Haematol 2024; 11:e127-e135. [PMID: 38142695 DOI: 10.1016/s2352-3026(23)00344-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND In a pivotal phase 3 trial of cytomegalovirus prophylaxis with letermovir for up to 100 days after allogeneic haematopoietic stem-cell transplantation (HSCT), 12% of participants developed clinically significant cytomegalovirus infection after letermovir was discontinued. We aimed to evaluate the efficacy and safety of extending the duration of letermovir prophylaxis for clinically significant cytomegalovirus infection from 100 days to 200 days following HSCT. METHODS We conducted a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial at 32 sites in six countries (France, Germany, Italy, Japan, the UK, and the USA). Cytomegalovirus‑seropositive HSCT recipients (aged ≥18 years) who had received letermovir prophylaxis for up to 100 days following HSCT and who remained at high risk of late clinically significant cytomegalovirus infection (with no previous history of clinically significant cytomegalovirus infection, defined as initiation of pre-emptive therapy for documented cytomegalovirus viraemia, onset of cytomegalovirus end-organ disease, or both) were eligible. Participants were randomly assigned (2:1) to receive either an additional 100 days (ie, a total of 200 days; letermovir group) of oral or intravenous letermovir 480 mg once daily, adjusted to 240 mg once daily for participants on cyclosporin A, or 100 days of a placebo comparator for letermovir (ie, a total of 100 days of letermovir; placebo group), following HSCT. Randomisation was done using a central interactive response technology system, stratified by study centre and haploidentical donor (yes or no). Participants, investigators, and sponsor personnel were masked to the treatment allocation. The primary efficacy endpoint was the proportion of participants from randomisation to week 28 (200 days after HSCT) with clinically significant cytomegalovirus infection, analysed using the full analysis set population (ie, those who received at least one dose of study intervention). Safety was analysed in all participants as treated (ie, those who received at least one dose according to the study intervention they were assigned to). This study is registered with ClinicalTrials.gov, NCT03930615, and is complete. FINDINGS Between June 21, 2019, and March 16, 2022, 255 patients were screened for eligibility and 220 (86%) were randomly assigned (145 [66%] in the letermovir group and 75 [34%] in the placebo group). Between randomisation and week 28, four (3%) of 144 participants in the letermovir group and 14 (19%) of 74 in the placebo group developed clinically significant cytomegalovirus infection (treatment difference -16·1% [95% CI -25·8 to -6·5]; p=0·0005). The most common adverse events among participants in the letermovir group versus the placebo group were graft-versus-host disease (43 [30%] vs 23 [31%]), diarrhoea (17 [12%] vs nine [12%]), nausea (16 [11%] vs 13 [18%]), pyrexia (13 [9%] vs nine [12%]), and decreased appetite (six [4%] vs nine [12%]). The most frequently reported serious adverse events were recurrent acute myeloid leukaemia (six [4%] vs none) and pneumonia (three [2%] vs two [3%]). No deaths were considered to be drug-related by the investigator. INTERPRETATION Extending the duration of letermovir prophylaxis to 200 days following HSCT is efficacious and safe in reducing the incidence of late clinically significant cytomegalovirus infection in patients at risk. FUNDING Merck Sharp & Dohme LLC.
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Affiliation(s)
- Domenico Russo
- Unit of Blood Diseases and Bone Marrow Transplantation, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Michael Schmitt
- Department of Hematology, Oncology, and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sylvain Pilorge
- Department of Hematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Matthias Stelljes
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - Toshiro Kawakita
- National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | | | | | | | | | - Cyrus Badshah
- Unit of Blood Diseases and Bone Marrow Transplantation, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
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4
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Chiuppesi F, Ortega-Francisco S, Gutierrez MA, Li J, Ly M, Faircloth K, Mack-Onyeike J, La Rosa C, Thomas S, Zhou Q, Drake J, Slape C, Fernando P, Rida W, Kaltcheva T, Grifoni A, Sette A, Patterson A, Dempsey S, Ball B, Ali H, Salhotra A, Stein A, Nathwani N, Rosenzweig M, Nikolaenko L, Al Malki MM, Dickter J, Nanayakkara DD, Puing A, Forman SJ, Taplitz RA, Zaia JA, Nakamura R, Wussow F, Diamond DJ, Dadwal SS. Stimulation of Potent Humoral and Cellular Immunity via Synthetic Dual-Antigen MVA-Based COVID-19 Vaccine COH04S1 in Cancer Patients Post Hematopoietic Cell Transplantation and Cellular Therapy. Vaccines (Basel) 2023; 11:1492. [PMID: 37766168 PMCID: PMC10538048 DOI: 10.3390/vaccines11091492] [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: 08/07/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Hematopoietic cell transplantation (HCT) and chimeric antigen receptor (CAR)-T cell patients are immunocompromised, remain at high risk following SARS-CoV-2 infection, and are less likely than immunocompetent individuals to respond to vaccination. As part of the safety lead-in portion of a phase 2 clinical trial in patients post HCT/CAR-T for hematological malignancies (HM), we tested the immunogenicity of the synthetic modified vaccinia Ankara-based COVID-19 vaccine COH04S1 co-expressing spike (S) and nucleocapsid (N) antigens. Thirteen patients were vaccinated 3-12 months post HCT/CAR-T with two to four doses of COH04S1. SARS-CoV-2 antigen-specific humoral and cellular immune responses, including neutralizing antibodies to ancestral virus and variants of concern (VOC), were measured up to six months post vaccination and compared to immune responses in historical cohorts of naïve healthy volunteers (HV) vaccinated with COH04S1 and naïve healthcare workers (HCW) vaccinated with the FDA-approved mRNA vaccine Comirnaty® (Pfizer, New York, NY, USA). After one or two COH04S1 vaccine doses, HCT/CAR-T recipients showed a significant increase in S- and N-specific binding antibody titers and neutralizing antibodies with potent activity against SARS-CoV-2 ancestral virus and VOC, including the highly immune evasive Omicron XBB.1.5 variant. Furthermore, vaccination with COH04S1 resulted in a significant increase in S- and N-specific T cells, predominantly CD4+ T lymphocytes. Elevated S- and N-specific immune responses continued to persist at six months post vaccination. Furthermore, both humoral and cellular immune responses in COH04S1-vaccinated HCT/CAR-T patients were superior or comparable to those measured in COH04S1-vaccinated HV or Comirnaty®-vaccinated HCW. These results demonstrate robust stimulation of SARS-CoV-2 S- and N-specific immune responses including cross-reactive neutralizing antibodies by COH04S1 in HM patients post HCT/CAR-T, supporting further testing of COH04S1 in immunocompromised populations.
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Affiliation(s)
- Flavia Chiuppesi
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Sandra Ortega-Francisco
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Miguel-Angel Gutierrez
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Jing Li
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Minh Ly
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Katelyn Faircloth
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Jada Mack-Onyeike
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Corinna La Rosa
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Sandra Thomas
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Qiao Zhou
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Jennifer Drake
- Clinical Trials Office, City of Hope National Medical Center, Duarte, CA 91010, USA; (J.D.); (C.S.); (P.F.)
| | - Cynthia Slape
- Clinical Trials Office, City of Hope National Medical Center, Duarte, CA 91010, USA; (J.D.); (C.S.); (P.F.)
| | - Paolo Fernando
- Clinical Trials Office, City of Hope National Medical Center, Duarte, CA 91010, USA; (J.D.); (C.S.); (P.F.)
| | - Wasima Rida
- Independent Researcher, Arlington, VA 22205, USA;
| | - Teodora Kaltcheva
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Alba Grifoni
- Division of Vaccine Discovery, La Jolla Institute of Allergy and Immunology, University of California San Diego, La Jolla, CA 92037, USA; (A.G.); (A.S.)
| | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute of Allergy and Immunology, University of California San Diego, La Jolla, CA 92037, USA; (A.G.); (A.S.)
| | - Angela Patterson
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Shannon Dempsey
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Brian Ball
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Haris Ali
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Amandeep Salhotra
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Anthony Stein
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Nitya Nathwani
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Michael Rosenzweig
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Liana Nikolaenko
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Monzr M. Al Malki
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Jana Dickter
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Deepa D. Nanayakkara
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Alfredo Puing
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Stephen J. Forman
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Randy A. Taplitz
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, CA 91010, USA; (R.A.T.); (S.S.D.)
- Department of Medicine, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - John A. Zaia
- Center for Gene Therapy, City of Hope National Medical Center, Duarte, CA 91010, USA;
| | - Ryotaro Nakamura
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Felix Wussow
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Don J. Diamond
- Department of Hematology and HCT, Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA; (F.C.); (S.O.-F.); (M.-A.G.); (J.L.); (K.F.); (J.M.-O.); (C.L.R.); (S.T.); (Q.Z.); (T.K.); (A.P.); (S.D.); (B.B.); (H.A.); (A.S.); (A.S.); (N.N.); (M.R.); (L.N.); (M.M.A.M.); (J.D.); (D.D.N.); (S.J.F.); (R.N.); (F.W.)
| | - Sanjeet S. Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, CA 91010, USA; (R.A.T.); (S.S.D.)
- Department of Medicine, City of Hope National Medical Center, Duarte, CA 91010, USA
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5
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Dadwal SS, Papanicolaou GA, Boeckh M. How I prevent viral reactivation in high-risk patients. Blood 2023; 141:2062-2074. [PMID: 36493341 PMCID: PMC10163320 DOI: 10.1182/blood.2021014676] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Preventing viral infections at an early stage is a key strategy for successfully improving transplant outcomes. Preemptive therapy and prophylaxis with antiviral agents have been successfully used to prevent clinically significant viral infections in hematopoietic cell transplant recipients. Major progress has been made over the past decades in preventing viral infections through a better understanding of the biology and risk factors, as well as the introduction of novel antiviral agents and advances in immunotherapy. High-quality evidence exists for the effective prevention of herpes simplex virus, varicella-zoster virus, and cytomegalovirus infection and disease. Few data are available on the effective prevention of human herpesvirus 6, Epstein-Barr virus, adenovirus, and BK virus infections. To highlight the spectrum of clinical practice, here we review high-risk situations that we handle with a high degree of uniformity and cases that feature differences in approaches, reflecting distinct hematopoietic cell transplant practices, such as ex vivo T-cell depletion.
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Affiliation(s)
- Sanjeet S. Dadwal
- Division of Infectious Disease, Department of Medicine, City of Hope National Medical Center, Duarte, CA
| | - Genovefa A. Papanicolaou
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Michael Boeckh
- Vaccine and Infectious and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
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Ford ES, Papanicolaou GA, Dadwal SS, Pergam S, Spallone A. Frequently Asked Questions about Mpox (Formerly Monkeypox Disease) for Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T Cell Recipients from the American Society for Transplantation and Cellular Therapy. Transplant Cell Ther 2023; 29:289-292. [PMID: 36746374 PMCID: PMC9899127 DOI: 10.1016/j.jtct.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Emily S Ford
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington; Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | | | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California
| | - Steve Pergam
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington; Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Amy Spallone
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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8
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Bergin SP, Chemaly RF, Duttagupta R, Bigelow R, Dadwal SS, Hill JA, Lee YJ, Haidar G, Luk A, Drelick AC, Chin-Hong PV, Benamu E, Davis T, Wolf O, McClain MT, Maziarz EK, Madut D, Bedoya A, Gilstrap DL, Todd J, Barkauskas C, Puing A, Spallone A, McDowell BJ, Shariff D, Salsgiver E, Nanayakkara DD, Khawaja F, Papanicolaou G, Spagnoletti J, English M, Fung M, Russel P, Ibrahimi S, Pandey S, Adams S, Liang W, Nemirovich-Danchenko E, Mughar M, Dalai S, Dalai S, Cho Y, Ahmed AA, Hollemon D, Hong DK, Vaughn ML, Blauwkamp T, Vucetic Z, Romano R, Romano R, Romano R, Fowler VG, Holland TL. 544. PICKUP: Pneumonia in the Immunocompromised - Use of the Karius Test for Detection of Undiagnosed Pathogens. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Pneumonia is the most common infectious cause of morbidity and excess mortality complicating hematopoietic cell transplantation (HCT) and treatment of hematologic malignancy. Standard bronchoscopic and noninvasive microbiologic testing identify causative pathogens in less than half of cases. The Karius Test, a plasma next-generation sequencing assay of microbial cell-free DNA, may improve diagnostic yield in these patients.
Methods
Patients with active hematologic malignancy or recent HCT undergoing bronchoscopy for suspected pneumonia were prospectively enrolled in this observational study conducted at 10 United States medical centers. A panel of expert clinicians blinded to Karius Test results reviewed a standardized panel of microbiologic and molecular testing from bronchoalveolar lavage and blood samples for bacterial and fungal testing, nasopharyngeal swab for respiratory viral testing, imaging results, clinical documentation, and any additional microbiologic or molecular testing collected per usual standard of care to adjudicate a probable cause of pneumonia. The panel then adjudicated whether a probable cause of pneumonia or other clinically relevant infection was identified by the Karius Test.
Results
Between January 3, 2020 and February 4, 2022, 257 patients were enrolled. A planned interim analysis of the first 69 sequentially enrolled patients in the per protocol population was conducted. An adjudicated probable cause of pneumonia was identified by standard care in 18/69 (26%) patients. The Karius Test identified an adjudicated probable cause of pneumonia in 10/51 (20%) patients when no cause of pneumonia was identified by standard care testing. The combination of standard care and the Karius Test together identified a probable cause of pneumonia in 28/69 (41%) patients. At least one additional pathogen adjudicated as a probable cause of pneumonia was identified by the Karius Test in 6/18 (33%) of patients with positive standard care testing.
Conclusion
The Karius Test notably increased the probability of identifying a pathogenic cause of pneumonia among immunocompromised patients undergoing bronchoscopy. The additive diagnostic value of the Karius Test may significantly enhance management of this common condition.
Disclosures
Roy F. Chemaly, MD/MPH, Karius: Advisor/Consultant|Karius: Grant/Research Support Radha Duttagupta, PhD, Karius Inc: Stocks/Bonds Sanjeet S. Dadwal, MD, FACP, FIDSA, AlloVir: Advisor/Consultant|AlloVir: Grant/Research Support|Ansun Biopharma: Grant/Research Support|Aseptiscope: Advisor/Consultant|Aseptiscope: Stocks/Bonds|Astellas: Speaker's Bureau|Cidara: Advisor/Consultant|Gilead: Grant/Research Support|Karius: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Speaker's Bureau|Takeda: Speaker's Bureau Joshua A. Hill, MD, Allovir: Advisor/Consultant|Allovir: Grant/Research Support|Covance/CSL: Advisor/Consultant|CRISPR: Advisor/Consultant|Deverra: Grant/Research Support|Gilead: Grant/Research Support|Karius: Advisor/Consultant|Karius: Grant/Research Support|Merck: Grant/Research Support|Octapharma: Advisor/Consultant|OptumHealth: Advisor/Consultant|Oxford Immunotec: Grant/Research Support|Pfizer: Advisor/Consultant|Symbio: Advisor/Consultant|Takeda: Advisor/Consultant Ghady Haidar, MD, Karius, Allovir, and AstraZeneca: Grant/Research Support Alfred Luk, MD, Karius: Grant/Research Support Jamie Todd, MD, Altavant Sciences: Advisor/Consultant|AstraZeneca: Grant/Research Support|Boehringer Ingelheim: Grant/Research Support|CareDx: Grant/Research Support|Cellarity: Advisor/Consultant|Natera: Advisor/Consultant Genovefa Papanicolaou, MD, AlloVir: Board Member|AlloVir: Serve as member of DSMC|Amplyx: Board Member|Amplyx: Serve as member of DSMC|Astellas: Advisor/Consultant|Cidara: Advisor/Consultant|CSL Behring: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Investigator for Merck|MSD: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Board Member|Octapharma: Serve as EAC member|Partners RX: Advisor/Consultant|SymBio: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Grant/Research Support|Takeda: Investigator for Takeda|Vera: Board Member|Vera: Serve as member of DSMC Elena Nemirovich-Danchenko, MD PhD, Karius: Stocks/Bonds Mona Mughar, BS, Karius: Stocks/Bonds Sudeb Dalai, MD, Karius: Stocks/Bonds Sudeb Dalai, MD, Karius: Stocks/Bonds Yuen Cho, MS, CLS(CA-DPH), Karius: Stocks/Bonds Asim A. Ahmed, MD, Karius: Employee|Karius: Stocks/Bonds Desiree Hollemon, MSN, MPH, Karius: Stocks/Bonds David K. Hong, MD, Janssen Pharmaceutical Companies of Johnson & Johnson: Employee|Vir Biotechnology: Employee|Vir Biotechnology: Stocks/Bonds Marla Lay Vaughn, BS, MT(ASCP), Karius: Employee|Karius: Stocks/Bonds Tim Blauwkamp, PhD, Karius: Board Member|Karius: Ownership Interest Zivjena Vucetic, MD, Karius: Stocks/Bonds Rina Romano, BS, Karius Inc: Stocks/Bonds|Karius Inc: Stocks/Bonds Rina Romano, BS, Karius Inc: Stocks/Bonds|Karius Inc: Stocks/Bonds Rina Romano, BS, Karius Inc: Stocks/Bonds|Karius Inc: Stocks/Bonds Vance G. Fowler, Jr, MD, MHS, Affinergy: Grant/Research Support|Affinergy: Honoraria|Affinium: Honoraria|Amphliphi Biosciences: Honoraria|ArcBio: Stocks/Bonds|Basilea: Grant/Research Support|Basilea: Honoraria|Bayer: Honoraria|C3J: Honoraria|Cerexa/Forest/Actavis/Allergan: Grant/Research Support|Contrafect: Grant/Research Support|Contrafect: Honoraria|Cubist/Merck: Grant/Research Support|Debiopharm: Grant/Research Support|Deep Blue: Grant/Research Support|Destiny: Honoraria|Genentech: Grant/Research Support|Genentech: Honoraria|Integrated Biotherapeutics: Honoraria|Janssen: Grant/Research Support|Janssen: Honoraria|Karius: Grant/Research Support|Medicines Co.: Honoraria|MedImmune: Grant/Research Support|MedImmune: Honoraria|NIH: Grant/Research Support|Novartis: Grant/Research Support|Novartis: Honoraria|Pfizer: Grant/Research Support|Regeneron: Grant/Research Support|Regeneron: Honoraria|Sepsis diagnostics: Sepsis diagnostics patent pending|UpToDate: Royalties|Valanbio: Stocks/Bonds Thomas L. Holland, MD, Aridis: Advisor/Consultant|Lysovant: Advisor/Consultant.
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Affiliation(s)
| | | | | | | | | | - Joshua A Hill
- Fred Hutchinson Cancer Center; University of Washington , Seattle, Washington
| | - Yeon Joo Lee
- Memorial Sloan Kettering Cancer Center , New York, New York
| | - Ghady Haidar
- University of Pittsburgh School of Medicine , Pittsburg, PA
| | - Alfred Luk
- Tulane University , New Orleans, Louisiana
| | | | | | | | | | | | | | | | - Deng Madut
- Duke University , Durham, North Carolina
| | | | | | | | | | | | - Amy Spallone
- University of Texas MD Anderson Cancer Center , Houston, Texas
| | | | | | | | | | - Fareed Khawaja
- The University of Texas MD Anderson Cancer Center , Houston, Texas
| | | | - Jack Spagnoletti
- Weill Cornell Medicine, NewYork-Presbyterian Hospital , New York, New York
| | | | | | | | | | | | | | | | | | | | | | | | - Yuen Cho
- Karius , Redwood City, California
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Hill JA, Lee YJ, Vande Vusse LK, Xie H, Lisa Chung E, Keane-Candib J, Waghmare A, Cheng GS, Zhu H, Huang ML, Hill G, Jerome KR, Gharib SA, Leisenring WM, Zerr DM, Dadwal SS, Boeckh MJ. 2094. A prospective multicenter study of HHV-6B genomic DNA and gene transcription in paired bronchoalveolar lavage fluid and blood from HCT recipients. Open Forum Infect Dis 2022. [PMCID: PMC9752744 DOI: 10.1093/ofid/ofac492.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background We previously demonstrated frequent detection of HHV-6B DNA in bronchoalveolar lavage fluid (BALF) and its positive association with mortality in HCT recipients from 1992-2015 with lower respiratory tract disease (LRTD). Whether these findings remain pertinent in contemporary patients, the additive value of testing for viral gene transcription, and the correlation of HHV-6 detection in blood and BALF, are unknown. Methods We conducted a prospective study of allogeneic HCT recipients undergoing BAL for LRTD within 120 days of HCT at three cancer centers from 2015-2019. We collected and tested paired blood and BALF for HHV-6B DNA by qPCR and HHV-6B mRNA (U38 and U90 gene transcripts) among DNA positive samples using RT-qPCR. We described the detection of HHV-6B DNA and mRNA in blood and BALF, generated receiver operating characteristic (ROC) curves to determine the ability of BALF HHV-6B DNA detection to predict HHV-6B mRNA detection, and analyzed the association of HHV-6B DNA detection with mortality. Results We enrolled 116 allogeneic HCT recipients who underwent 125 BALs. HHV-6B DNA was detected in 45 of 122 BALF (37%) compared to 19 of 124 (15%) plasma samples. Among the 45 BALF samples with HHV-6B DNA detected, either HHV-6B mRNA transcript was detected in 22 (49%) (Figure 1). BALF HHV-6B DNA ≥ 218 copies/ml had an area under the curve of 0.93 for predicting detection of BALF viral mRNA (Figure 2). In turn, patients with BALF HHV-6B DNA ≥ 218 copies/mL had increased risk for mortality and death due to LRTD within 60 days after the BAL (Figure 3). This association remained after adjustment for age, oxygen use, and steroid use at the time of BAL in a multivariable Cox model (Figure 3).
![]() ![]() ![]() Conclusion HHV-6B was detected more frequently in BALF than plasma, suggesting compartment-specific reactivation. BALF HHV-6B DNA ≥ 218 copies/mL had high sensitivity and specificity for detection of viral gene transcription in BALF and was associated with increased mortality; this viral load is strikingly similar to the BALF viral load threshold of 251 copies/mL associated with mortality in our prior retrospective study. Together, these data suggest transcriptionally active HHV-6B is a clinically impactful pulmonary pathogen in contemporary HCT recipients. Disclosures Joshua A. Hill, MD, Allovir: Advisor/Consultant|Allovir: Grant/Research Support|Covance/CSL: Advisor/Consultant|CRISPR: Advisor/Consultant|Deverra: Grant/Research Support|Gilead: Grant/Research Support|Karius: Advisor/Consultant|Karius: Grant/Research Support|Merck: Grant/Research Support|Octapharma: Advisor/Consultant|OptumHealth: Advisor/Consultant|Oxford Immunotec: Grant/Research Support|Pfizer: Advisor/Consultant|Symbio: Advisor/Consultant|Takeda: Advisor/Consultant Alpana waghmare, MD, Allovir: Grant/Research Support|Ansun BioPharma: Grant/Research Support|Kyorin Pharmaceutical: Advisor/Consultant|Pfizer: Grant/Research Support|Vir/GSK: Grant/Research Support Geoffrey Hill, M.D., FRACP, FRCPA, Applied Molecular Transport: Grant/Research Support|Compass Therapeutics: Grant/Research Support|Generon Corporation: Advisor/Consultant|Heat Biologics: Grant/Research Support|iTeos Therapeutics: Advisor/Consultant|iTeos Therapeutics: Grant/Research Support|Laevoroc Oncology: Grant/Research Support|NapaJen Pharma: Advisor/Consultant|Neoleukin Therapeutics: Advisor/Consultant|Serplus Technology: Grant/Research Support|Syndax Pharmaceuticals: Grant/Research Support Danielle M. Zerr, MD MPH, AlloVir: Advisor/Consultant Sanjeet S. Dadwal, MD, FACP, FIDSA, AlloVir: Advisor/Consultant|AlloVir: Grant/Research Support|Ansun Biopharma: Grant/Research Support|Aseptiscope: Advisor/Consultant|Aseptiscope: Stocks/Bonds|Astellas: Speaker's Bureau|Cidara: Advisor/Consultant|Gilead: Grant/Research Support|Karius: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Speaker's Bureau|Takeda: Speaker's Bureau Michael J. Boeckh, MD PhD, Allovir: Advisor/Consultant|Amazon: Grant/Research Support|Ansun Biopharma: Grant/Research Support|EvrysBio: Advisor/Consultant|Gates Ventures: Grant/Research Support|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Helocyte: Advisor/Consultant|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kyorin Pharmaceuticals: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Regeneron: Grant/Research Support|ReViral: Advisor/Consultant|Symbio: Advisor/Consultant|Takeda: Grant/Research Support|Vir Biotechnology: Advisor/Consultant|Vir Biotechnology: Grant/Research Support.
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Affiliation(s)
- Joshua A Hill
- Fred Hutchinson Cancer Center; University of Washington, Seattle, Washington
| | - Yeon Joo Lee
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College, New York, New York
| | | | - Hu Xie
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - E Lisa Chung
- Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Alpana Waghmare
- Fred Hutchinson Cancer Center; Seattle Children's Hospital, Seattle, Washington
| | - Guang-Shing Cheng
- University of Washington; Fred Hutchinson Cancer Center, Seattle, Washington
| | - Haiying Zhu
- University of Washington, Seattle, Washington
| | | | | | | | | | | | - Danielle M Zerr
- University of Washington; Seattle Children's Research Institute, Seattle, Washington
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10
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Dadwal SS, Shuster M, Myers D, Boundy K, Warren M, Stoner E, Truong T, Hill JA. Posoleucel (ALVR105), an Off-the-Shelf, Multivirus-Specific T-Cell Therapy, for the Prevention of Viral Infections Post-Allogeneic Hematopoietic Cell Transplantation (allo-HCT): Results from an Open-Label Cohort of a Phase 2 Trial. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00631-5] [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: 11/28/2022]
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11
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Barreto JN, Aitken SL, Krantz EM, Nagel JL, Dadwal SS, Seo SK, Liu C. Variation in Clinical Practice and Attitudes on Antibacterial Management of Fever and Neutropenia in Patients With Hematologic Malignancy: A Survey of Cancer Centers Across the United States. Open Forum Infect Dis 2022; 9:ofac005. [PMID: 35155714 PMCID: PMC8830528 DOI: 10.1093/ofid/ofac005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
Background Contemporary information regarding fever and neutropenia (FN) management, including approaches to antibacterial prophylaxis, empiric therapy, and de-escalation across US cancer centers, is lacking. Methods This was a self-administered, electronic, cross-sectional survey of antimicrobial stewardship physicians and pharmacists at US cancer centers. The survey ascertained institutional practices and individual attitudes on FN management in high-risk cancer patients. A 5-point Likert scale assessed individual attitudes. Results Providers from 31 of 86 hospitals (36%) responded, and FN management guidelines existed in most (29/31, 94%) hospitals. Antibacterial prophylaxis was recommended in 27/31 (87%) hospitals, with levofloxacin as the preferred agent (23/27, 85%). Cefepime was the most recommended agent for empiric FN treatment (26/29, 90%). Most institutional guidelines (26/29, 90%) recommended against routine addition of empiric gram-positive agents except for specific scenarios. Eighteen of 29 (62%) hospitals explicitly provided guidance on de-escalation of empiric, systemic antibacterial therapy; however, timing of de-escalation was variable according to clinical scenario. Among 34 individual respondents, a majority agreed with use of antibiotic prophylaxis in high-risk patients (25, 74%). Interestingly, only 10 (29%) respondents indicated agreement with the statement that benefits of antibiotic prophylaxis outweigh potential harms. Conclusion Most US cancer centers surveyed had institutional FN management guidelines. Antibiotic de-escalation guidance was lacking in nearly 40% of centers, with heterogeneity in approaches when recommendations existed. Further research is needed to inform FN guidelines on antibacterial prophylaxis and therapy de-escalation.
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Affiliation(s)
- Jason N Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel L Aitken
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth M Krantz
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jerod L Nagel
- Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California, USA
| | - Susan K Seo
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Catherine Liu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
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12
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Dickter JK, Ross JA, Zain JM, Tegtmeier BR, Lee BV, Dadwal SS. Letermovir and maribavir for pan-resistant cytomegalovirus infection in a patient with haematologic malignancy: Consideration for combination therapy. J Clin Pharm Ther 2022; 47:699-702. [PMID: 35023177 DOI: 10.1111/jcpt.13585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Management of pan-resistant cytomegalovirus infection (CMVi) requires a multifaceted approach, including host defence optimization by reducing immunosuppression, and standard or experimental antiviral therapy. CASE DESCRIPTION A 36-year-old man with anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma, who underwent allogeneic haematopoietic stem cell transplant (alloHCT) with resultant graft-versus-host disease treated with immunosuppressive therapy, developed pan-resistant CMVi. He was successfully treated with combination therapy of maribavir and letermovir. WHAT IS NEW AND CONCLUSION Combination therapy, used for other infections to prevent cross-resistant, may apply for CMVi.
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Affiliation(s)
- Jana K Dickter
- Department of Medicine, Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California, USA
| | - Justine A Ross
- Department of Pharmacy Services, City of Hope National Medical Center, Duarte, California, USA
| | - Jasmine M Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Bernard R Tegtmeier
- Department of Pathology, Division of Clinical Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Brian V Lee
- Department of Pharmacy Services, City of Hope National Medical Center, Duarte, California, USA
| | - Sanjeet S Dadwal
- Department of Medicine, Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California, USA
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13
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Sun Y, Dong W, Tian L, Rao Y, Qin C, Jaramillo SA, Settles EW, Ma S, Zhang J, Yu K, Xu B, Yan J, Ma R, Li Z, Dadwal SS, Barker BM, Keim PS, Feng P, Caligiuri MA, Yu J. Dual roles of a novel oncolytic viral vector-based SARS-CoV-2 vaccine: preventing COVID-19 and treating tumor progression. bioRxiv 2021. [PMID: 34127971 DOI: 10.1101/2021.06.07.447286] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer patients are usually immunocompromised and thus are particularly susceptible to SARS-CoV-2 infection resulting in COVID-19. Although many vaccines against COVID-19 are being preclinically or clinically tested or approved, none have yet been specifically developed for cancer patients or reported as having potential dual functions to prevent COVID-19 and treat cancer. Here, we confirmed that COVID-19 patients with cancer have low levels of antibodies against the spike (S) protein, a viral surface protein mediating the entry of SARS-CoV-2 into host cells, compared with COVID-19 patients without cancer. We developed an oncolytic herpes simplex virus-1 vector-based vaccine named oncolytic virus (OV)-spike. OV-spike induced abundant anti-S protein neutralization antibodies in both tumor-free and tumor-bearing mice, which inhibit infection of VSV-SARS-CoV-2 and wild-type (WT) live SARS-CoV-2 as well as the B.1.1.7 variant in vitro. In the tumor-bearing mice, OV-spike also inhibited tumor growth, leading to better survival in multiple preclinical tumor models than the untreated control. Furthermore, OV-spike induced anti-tumor immune response and SARS-CoV-2-specific T cell response without causing serious adverse events. Thus, OV-spike is a promising vaccine candidate for both preventing COVID-19 and enhancing the anti-tumor response. One Sentence Summary A herpes oncolytic viral vector-based vaccine is a promising vaccine with dual roles in preventing COVID-19 and treating tumor progression.
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14
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Semis M, Dadwal SS, Tegtmeier BR, Wilczynski SP, Ito JI, Kalkum M. First Case of Invasive Stachybotrys Sinusitis. Clin Infect Dis 2021; 72:1386-1391. [PMID: 32155243 DOI: 10.1093/cid/ciaa231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/05/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The toxigenic mold Stachybotrys has controversially been linked to idiopathic pulmonary hemorrhage and "sick building syndrome." However, there are no previous clinical records of invasive stachybotryosis. METHODS Sinus biopsy specimens from a 23-year-old male with refractory acute lymphocytic leukemia were obtained at 3 different time points during the patient's hospitalization (139 days) and examined by histopathology and immunohistochemistry (IHC). Antifungal susceptibility testing and fungal speciation using multilocus sequence typing were performed. RESULTS Hemorrhage, fungal germination, and hyphal growth were observed in the first sinus biopsy tissues. Areas with fungal growth tested positive for Stachybotrys by IHC. Fungal isolates were genotyped and identified as Stachybotrys chlorohalonata. The patient was cured from Stachybotrys sinusitis following sinus surgery and antifungal treatment. While a subsequent second sinus biopsy and a bronchoscopy showed no signs of fungal infection, a later, third sinus biopsy tested positive for Aspergillus calidoustus, a rare human pathogen. CONCLUSIONS Here, we report the first case of invasive S. chlorohalonata sinusitis that was surgically and medically cured but followed by invasive A. calidoustus sinusitis in the setting of refractory leukemia. Our findings emphasize the risk for unusual fungal infections in severely immunocompromised patients.
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Affiliation(s)
- Margarita Semis
- Department of Molecular Imaging and Therapy, Diabetes and Metabolism Research Institute, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope, Duarte, California, USA
| | | | | | - James I Ito
- Department of Molecular Imaging and Therapy, Diabetes and Metabolism Research Institute, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Markus Kalkum
- Department of Molecular Imaging and Therapy, Diabetes and Metabolism Research Institute, Beckman Research Institute, City of Hope, Duarte, California, USA
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15
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Pergam SA, Dadwal SS. Can a Simple Stool Swab Predict Bacteremia in High-Risk Hematopoietic Cell Transplant Recipients? Clin Infect Dis 2021; 73:1266-1267. [PMID: 33961692 DOI: 10.1093/cid/ciab412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Steven A Pergam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Medicine, University of Washington, Seattle, WA.,Infection Prevention, Seattle Cancer Care Alliance, Seattle, WA
| | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, CA
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16
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Chemaly RF, Dadwal SS, Bergeron A, Ljungman P, Kim YJ, Cheng GS, Pipavath SN, Limaye AP, Blanchard E, Winston DJ, Stiff PJ, Zuckerman T, Lachance S, Rahav G, Small CB, Mullane KM, Patron RL, Lee DG, Hirsch HH, Waghmare A, McKevitt M, Jordan R, Guo Y, German P, Porter DP, Gossage DL, Watkins TR, Marty FM, Chien JW, Boeckh M. A Phase 2, Randomized, Double-blind, Placebo-Controlled Trial of Presatovir for the Treatment of Respiratory Syncytial Virus Upper Respiratory Tract Infection in Hematopoietic-Cell Transplant Recipients. Clin Infect Dis 2021; 71:2777-2786. [PMID: 31793991 PMCID: PMC7108134 DOI: 10.1093/cid/ciz1166] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background Hematopoietic-cell transplant (HCT) recipients are at risk for severe respiratory syncytial virus (RSV) infection. We evaluated the RSV fusion inhibitor presatovir in a randomized, double-blind, Phase II trial in HCT recipients with RSV upper respiratory tract infections. Methods Patients were stratified by lymphopenia (<200/µL) and ribavirin use; were randomized, stratified by lymphopenia (<200/μL) and ribavirin use, to receive oral presatovir at 200 mg or a placebo on Days 1, 5, 9, 13, and 17, and were followed through Day 28. The coprimary efficacy endpoints were the time-weighted average change in the nasal RSV viral load between Days 1 and 9 and the proportion of patients developing lower respiratory tract complications (LRTCs) through Day 28. Results From 23 January 2015 to 16 June 2017, 189 patients were randomly assigned to treatment (96 to presatovir and 93 to the placebo). Presatovir treatment, compared with the placebo treatment, did not significantly affect (prespecified α = 0.01) a time-weighted average decline in the RSV viral load from Day 1 to 9 (treatment difference, −0.33 log10 copies/mL; 95% confidence interval [CI] −.64 to −.02 log10 copies/mL; P = .040) or the progression to LRTC (11.2% vs 19.5%, respectively; odds ratio, 0.50; 95% CI, .22–1.18; P = .11). In a post hoc analysis among patients with lymphopenia, presatovir decreased LRTC development by Day 28 (2/15 [13.3%] vs 9/14 [64.3%], respectively; P = .008), compared with the placebo. Adverse events were similar for patients receiving presatovir and the placebo. Conclusions Presatovir had a favorable safety profile in adult HCT recipients with RSV but did not achieve the coprimary endpoints. Exploratory analyses suggest an antiviral effect among patients with lymphopenia. Clinical Trials Registration NCT02254408; EUDRA-CT#2014-002474-36.
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Affiliation(s)
- Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjeet S Dadwal
- Division of Infectious Disease, City of Hope National Medical Center, Duarte, California, USA
| | - Anne Bergeron
- Service de Pneumologie, Université Paris Diderot, Hôpital Saint Louis, Paris, France
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Guang-Shing Cheng
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sudhakar N Pipavath
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ajit P Limaye
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elodie Blanchard
- Department of Respiratory Diseases, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Drew J Winston
- Department of Medicine, University of California Los Angeles Ronald Reagan Medical Center, Los Angeles, California, USA
| | - Patrick J Stiff
- Department of Hematology/Oncology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Tsila Zuckerman
- Hematology Institute, Rambam Medical Health Care Campus, Haifa, Israel
| | - Silvy Lachance
- Hematology-Oncology Department, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Galia Rahav
- Infectious Diseases Unit, Chaim Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Catherine B Small
- Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Kathleen M Mullane
- Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Roberto L Patron
- Department of Infectious Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Dong-Gun Lee
- Department of Infectious Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hans H Hirsch
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Alpana Waghmare
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - Ying Guo
- Gilead Sciences Inc., Foster City, California, USA
| | | | | | | | | | - Francisco M Marty
- Department of Infectious Disease, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
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17
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Dadwal SS, Hohl TM, Fisher CE, Boeckh M, Papanicolaou G, Carpenter PA, Fisher BT, Slavin MA, Kontoyiannis DP. American Society of Transplantation and Cellular Therapy Series, 2: Management and Prevention of Aspergillosis in Hematopoietic Cell Transplantation Recipients. Transplant Cell Ther 2021; 27:201-211. [PMID: 33781516 PMCID: PMC9088165 DOI: 10.1016/j.jtct.2020.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022]
Abstract
The Practice Guidelines Committee of the American Society of Transplantation and Cellular Therapy partnered with its Transplant Infectious Disease Special Interest Group to update its 2009 compendium-style infectious disease guidelines for hematopoietic cell transplantation (HCT). A completely fresh approach was taken with the goal of better serving clinical providers by publishing each standalone topic in the infectious disease series as a concise format of frequently asked questions (FAQs), tables, and figures. Adult and pediatric infectious disease and HCT content experts developed, then answered FAQs, and finalized topics with harmonized recommendations that were made by assigning an A through E strength of recommendation paired with a level of supporting evidence graded I through III. This second guideline in the series focuses on invasive aspergillosis, a potentially life-threatening infection in the peri-HCT period. The relevant risk factors, diagnostic considerations, and prophylaxis and treatment approaches are reviewed.
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Affiliation(s)
- Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California.
| | - Tobias M Hohl
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cynthia E Fisher
- Division of Infectious Diseases, University of Washington, Seattle, Washington
| | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Genofeva Papanicolaou
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brian T Fisher
- Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania
| | - Monica A Slavin
- Department of Infectious Disease, and National Center for Infections in Cancer, Peter McCallum Cancer Center, Melbourne, Victoria, Australia
| | - D P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
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18
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Abstract
Critically ill patients with cancer are vulnerable to infections because of the underlying malignancy, tumor-directed therapy, immunosuppression, breaches in mucosa or skin, malnutrition, and other factors. Neutropenia remains the most important risk factor for infection. Infectious complications occurring in critically ill patients with cancer can affect the bloodstream, lungs, gastrointestinal tract, central nervous system, urinary tract, and the skin. Pneumonias are the leading cause of infection in patients with cancer admitted to the intensive care unit. Consideration of opportunistic pathogens in the differential diagnosis is important in patients with impaired cellular and/or humoral immunity or compromised splenic function.
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Affiliation(s)
- Susan K Seo
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Catherine Liu
- Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sanjeet S Dadwal
- Division of Infectious Diseases, Department of Medicine, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
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19
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Marty FM, Chemaly RF, Mullane KM, Lee DG, Hirsch HH, Small CB, Bergeron A, Shoham S, Ljungman P, Waghmare A, Blanchard E, Kim YJ, McKevitt M, Porter DP, Jordan R, Guo Y, German P, Boeckh M, Watkins TR, Chien JW, Dadwal SS. A Phase 2b, Randomized, Double-blind, Placebo-Controlled Multicenter Study Evaluating Antiviral Effects, Pharmacokinetics, Safety, and Tolerability of Presatovir in Hematopoietic Cell Transplant Recipients with Respiratory Syncytial Virus Infection of the Lower Respiratory Tract. Clin Infect Dis 2020; 71:2787-2795. [PMID: 31915807 PMCID: PMC7108198 DOI: 10.1093/cid/ciz1167] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Presatovir significantly reduced nasal viral load, signs, and symptoms of respiratory syncytial virus (RSV) infection in a human challenge study. We evaluated presatovir in hematopoietic-cell transplant (HCT) recipients with RSV lower respiratory tract infection (LRTI). METHODS Patients with confirmed RSV in upper and lower respiratory tract and new chest X-ray abnormalities were randomized (1:1), stratified by supplemental oxygen and ribavirin use, to receive oral presatovir 200 mg or placebo every 4 days for 5 doses. The primary endpoint was time-weighted average change in nasal RSV viral load through day 9. Secondary endpoints included supplemental oxygen-free days, incident respiratory failure requiring mechanical ventilation, and all-cause mortality. RESULTS From January 31, 2015, to March 20, 2017, 60 patients from 17 centers were randomized (31 presatovir, 29 placebo); 59 received study treatment (50 allogeneic, 9 autologous HCT). In the efficacy population (29 presatovir, 28 placebo), presatovir treatment did not significantly reduce time-weighted average change in viral load (-1.12 vs -1.09 log10 copies/mL; treatment difference -0.02 log10 copies/mL, 95% confidence interval: -.62, .57; P = .94), median supplemental oxygen-free days (26 vs 28 days, P = .84), incident respiratory failure (10.3 vs 10.7%, P = .98), or all-cause mortality (0 vs 7.1%, P = .19) versus placebo. Adverse events were similar between arms (presatovir 80%, placebo 79%). Resistance-associated substitutions in RSV fusion protein emerged in 6/29 presatovir-treated patients. CONCLUSIONS Presatovir treatment was well tolerated in HCT patients with RSV LRTI but did not improve virologic or clinical outcomes versus placebo. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov, NCT02254421; EudraCT, #2014-002475-29.
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Affiliation(s)
- Francisco M Marty
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kathleen M Mullane
- Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Dong-Gun Lee
- Department of Infectious Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hans H Hirsch
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Catherine B Small
- Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Anne Bergeron
- Service de pneumologie, Univ Paris Diderot, Hôpital Saint Louis, Paris, France
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Alpana Waghmare
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elodie Blanchard
- Department of Respiratory Diseases, CHU de Bordeaux, Bordeaux, France
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | - Ying Guo
- Gilead Sciences, Inc., Foster City, California, USA
| | | | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - Sanjeet S Dadwal
- Division of Infectious Disease, City of Hope National Medical Center, Duarte, California, USA
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Chemaly RF, El Haddad L, Winston DJ, Rowley SD, Mulane KM, Chandrasekar P, Avery RK, Hari P, Peggs KS, Kumar D, Nath R, Ljungman P, Mossad SB, Dadwal SS, Blanchard T, Shah DP, Jiang Y, Ariza-Heredia E. Cytomegalovirus (CMV) Cell-Mediated Immunity and CMV Infection After Allogeneic Hematopoietic Cell Transplantation: The REACT Study. Clin Infect Dis 2020; 71:2365-2374. [PMID: 32076709 PMCID: PMC7713694 DOI: 10.1093/cid/ciz1210] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 08/15/2019] [Accepted: 01/02/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) infection remains an important cause of morbidity and mortality in allogeneic hematopoietic cell transplant (allo-HCT) recipients. CMV cell-mediated immunity (CMV-CMI) as determined by a peptide-based enzyme-linked immunospot (ELISPOT) CMV assay may identify patients at risk for clinically significant CMV infection (CS-CMVi). METHODS The CS-CMVi was defined as CMV viremia and/or disease necessitating antiviral therapy. CMV-CMI was characterized as high when the intermediate-early 1 (IE-1) antigen spot counts (SPCs) were >100 (cutoff 1) or when the IE-1 and phosphoprotein 65 antigen SPCs were both >100 SPCs per 250 000 cells (cutoff 2), and a low CMV-CMI when SPCs were below these thresholds. In this prospective multicenter study, we evaluated CMV-CMI every 2 weeks from the pretransplant period until 6 months posttransplantation in 241 allo-HCT recipients with positive CMV serostatus. The primary endpoint was CS-CMVi occurring within 2 weeks of the last measurement of CMV-CMI. RESULTS CS-CMVi occurred in 70 allo-HCT recipients (29%). CMV-CMI was low in patients who experienced CS-CMVi (94%), whereas those who had a high CMV-CMI were less likely to have CS-CMVi (P < .0001). Patients with CS-CMVi had higher all-cause mortality (P = .007), especially those with low CMV-CMI (P = .035). On multivariable analysis, CMV-CMI, sex, race, antithymocyte globulin, and steroid use were independent predictors of CS-CMVi, and the time from transplant to engraftment was the only predictor of mortality. CONCLUSIONS Measurement of CMV-CMI using a novel ELISPOT assay would be useful clinically to monitor allo-HCT recipients and distinguish between those at risk of developing CS-CMVi and requiring antiviral prophylaxis or therapy and those who are protected.
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Affiliation(s)
- Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lynn El Haddad
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Drew J Winston
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | | | - Kathleen M Mulane
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Pranatharthi Chandrasekar
- Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Robin K Avery
- Division of Infectious Diseases (Transplant Oncology), Johns Hopkins University, Baltimore, Maryland, USA
| | - Parameswaran Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Karl S Peggs
- Department of Haematology, University College London Cancer Institute and University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Deepali Kumar
- Transplant Infectious Diseases, University Health Network, Toronto, Ontario, Canada
| | - Rajneesh Nath
- Bone Marrow Transplant, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Sherif B Mossad
- Department of Infectious Diseases, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope, Duarte, California, USA
| | - Ted Blanchard
- Oxford Immunotec USA, Inc, Charlotte, North Carolina, USA
| | - Dimpy P Shah
- Department of Epidemiology and Biostatistics, University of Texas Health, San Antonio, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ella Ariza-Heredia
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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21
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Vasudevan RS, Horiuchi Y, Torriani FJ, Cotter B, Maisel SM, Dadwal SS, Gaynes R, Maisel AS. Persistent Value of the Stethoscope in the Age of COVID-19. Am J Med 2020; 133:1143-1150. [PMID: 32569591 PMCID: PMC7303610 DOI: 10.1016/j.amjmed.2020.05.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 12/25/2022]
Abstract
The stethoscope has long been at the center of patient care, as well as a symbol of the physician-patient relationship. While advancements in other diagnostic modalities have allowed for more efficient and accurate diagnosis, the stethoscope has evolved in parallel to address the needs of the modern era of medicine. These advancements include sound visualization, ambient noise reduction/cancellation, Bluetooth (Bluetooth SIG Inc, Kirkland, Wash) transmission, and computer algorithm diagnostic support. However, despite these advancements, the ever-changing climate of infection prevention, especially in the wake of the COVID-19 pandemic, has led many to question the stethoscope as a vector for infectious diseases. Stethoscopes have been reported to harbor bacteria with contamination levels comparable with a physician's hand. Although disinfection is recommended, stethoscope hygiene compliance remains low. In addition, disinfectants may not be completely effective in eliminating microorganisms. Despite these risks, the growing technological integration with the stethoscope continues to make it a highly valuable tool. Rather than casting our valuable tool and symbol of medicine aside, we must create and implement an effective method of stethoscope hygiene to keep patients safe.
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Affiliation(s)
- Rajiv S Vasudevan
- Department of Medicine, University of California San Diego, La Jolla.
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Francesca J Torriani
- Department of Medicine, University of California San Diego, La Jolla; Division of Infectious Diseases
| | - Bruno Cotter
- Department of Medicine, University of California San Diego, La Jolla; Division of Cardiovascular Medicine, University of California San Diego, La Jolla
| | | | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, Calif
| | - Robert Gaynes
- Division of Infectious Diseases, Emory University, Atlanta, Ga
| | - Alan S Maisel
- Department of Medicine, University of California San Diego, La Jolla; Division of Cardiovascular Medicine, University of California San Diego, La Jolla
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22
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Sy A, Wong L, Chanson D, Teh JB, Dadwal SS, Nakamura R, Armenian SH. Incidence and Risk Factors of Late-Occurring Infections in a Contemporary Cohort of Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.346] [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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23
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Chen J, Abella Ross J, Tegtmeier B, Yang D, Ito JI, Zaia JA, Dickter JK, Nakamura R, Mokhtari S, Kriengkauykiat J, Al Malki MM, Dadwal SS. Cost analysis of ganciclovir and foscarnet in recipients of allogeneic hematopoietic cell transplant with cytomegalovirus viremia. Transpl Infect Dis 2019; 22:e13233. [PMID: 31840347 DOI: 10.1111/tid.13233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/18/2019] [Accepted: 12/09/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ganciclovir (GCV) and foscarnet (FOS) are the most commonly used antivirals for preemptive treatment of cytomegalovirus (CMV) viremia in recipients of allogeneic hematopoietic cell transplantation (alloHCT). The current literature indicates similar efficacy between these agents. Thus, the primary consideration for choice of initial anti-CMV treatment is the safety profile, time period after alloHCT, and concern of myelosuppression or renal dysfunction. METHODS Herein, we retrospectively reviewed medical records of 124 alloHCT recipients who received GCV or FOS between April 27, 2014, and December 31, 2015, during the first year post-transplant. Healthcare resource use included drug, hospitalization, home health, dialysis, and growth factor costs. RESULTS Total duration of therapy was longer in the GCV group (37 days vs 28 days, P = .21) but hospitalization days were similar (9 days) in both groups. The total treatment cost was significantly lower in the GCV group ($38 100 vs $59 400, P < .05). CONCLUSION Preemptive anti-CMV therapy is associated with major healthcare resource costs, which were greater in patients who required FOS than those who were treated with GCV.
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Affiliation(s)
- Jason Chen
- Department of Pharmacy, City of Hope, Duarte, California
| | | | - Bernard Tegtmeier
- Department of Quality, Risk and Regulatory Management, City of Hope, Duarte, California
| | - Dongyun Yang
- Department of Information Sciences, City of Hope, Duarte, California
| | - James I Ito
- Department of Medicine, Division of Infectious Disease, City of Hope, Duarte, California
| | - John A Zaia
- Center for Gene Therapy, City of Hope, Duarte, California.,Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Jana K Dickter
- Department of Medicine, Division of Infectious Disease, City of Hope, Duarte, California
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Sally Mokhtari
- Department of Clinical Translational Program Development, City of Hope, Duarte, California
| | | | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Sanjeet S Dadwal
- Department of Medicine, Division of Infectious Disease, City of Hope, Duarte, California
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24
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Mascarenhas K, Teh JB, Peng K, Kim H, Sy A, Forman SJ, Wong FL, Nakamura R, Dadwal SS, Armenian SH. Efficacy of low-dose zoster prophylaxis in patients undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2019; 55:1662-1664. [PMID: 31616064 PMCID: PMC7391285 DOI: 10.1038/s41409-019-0717-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/09/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Kelly Peng
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Heeyoung Kim
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Andrew Sy
- Hyundai Cancer Institute, Children's Hospital of Orange County, Orange, CA, USA
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Sanjeet S Dadwal
- Division of Infectious Diseases, Department of Medical Specialties, City of Hope, Duarte, CA, USA
| | - Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, CA, USA.
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25
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Pergam SA, Englund JA, Kamboj M, Gans HA, Young JAH, Hill JA, Savani B, Chemaly RF, Dadwal SS, Storek J, Duchin J, Carpenter PA. Preventing Measles in Immunosuppressed Cancer and Hematopoietic Cell Transplantation Patients: A Position Statement by the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2019; 25:e321-e330. [PMID: 31394271 DOI: 10.1016/j.bbmt.2019.07.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022]
Abstract
Until recently, measles exposures were relatively rare and so, consequently, were an afterthought for cancer patients and/or blood and marrow transplant recipients and their providers. Declines in measles herd immunity have reached critical levels in many communities throughout the United States due to increasing vaccine hesitancy, so that community-based outbreaks have occurred. The reemergence of measles as a clinical disease has raised serious concerns among immunocompromised patients and those who work within the cancer and hematopoietic cell transplantation (HCT) community. Since live attenuated vaccines, such as measles, mumps, and rubella (MMR), are contraindicated in immunocompromised patients, and with no approved antiviral therapies for measles, community exposures in these patients can lead to life-threatening infection. The lack of data regarding measles prevention in this population poses a number of clinical dilemmas. Herein specialists in Infectious Diseases and HCT/cellular therapy endorsed by the American Society of Transplant and Cellular Therapy address frequently asked questions about measles in these high-risk cancer patients and HCT recipients and provide expert opinions based on the limited available data.
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Affiliation(s)
- Steven A Pergam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Mini Kamboj
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hayley A Gans
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jo-Anne H Young
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Bipin Savani
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California
| | - Jan Storek
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada
| | - Jeffery Duchin
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Public Health, Seattle & King County, Seattle, Washington
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington.
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26
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Papanicolaou GA, Dadwal SS, Marón GM, Chaudhury S, Hutcheson R, Chandak A, Vainorius E, Brundage TM, Mozaffari E, Nichols G, Dvorak CC. Screening and Treatment of Adenovirus Infection in Pediatric and Adult Allogeneic Hematopoietic Cell Transplant Recipients: Multicenter Survey of Transplant Centers in the United States. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.594] [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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Abstract
INTRODUCTION Fungal infection burden related to Mucorales has been on the rise with significant associated morbidity and mortality. The major obstacle in the management has been lack of a non-invasive rapid and a reliable diagnostic test. Developing a culture-independent biomarker for the early diagnosis of mucormycosis is a major unmet need in modern mycology. Several approaches have been developed, such as immunohistochemistry (IHC) that can confirm the histopathologic diagnosis of the invasive mold infection, polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded (FFPE) or fresh tissue, body fluids such as bronchoalveolar fluid (BAL), and detection directly from serum/blood. Serologic tests, matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS), metabolomics and metagenomic shotgun sequencing are other evolving technologies. Area covered: In this review paper, we report the current status of the molecular diagnostics in the diagnosis of mucormycosis: serologic tests, IHC, PCR, protein-based with MALDI-TOF, metabolomics and metagenomic sequencing. Expert commentary: This review will conclude with an expert commentary on the potential uses/challenges of the currently available tests and the future of molecular diagnostics for mucormycosis.
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Affiliation(s)
- Sanjeet S Dadwal
- a Division of Infectious Disease , City of Hope National Medical Center , Duarte , CA , USA
| | - Dimitrios P Kontoyiannis
- b Department of Infectious Diseases, Infection Control and Employee Health , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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28
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Reddy K, Htut M, Krishnan A, Dadwal SS. Aseptic Meningitis as a Complication of Daratumumab Therapy. Clin Lymphoma Myeloma Leuk 2018; 18:e333-e335. [PMID: 29903471 DOI: 10.1016/j.clml.2018.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/07/2018] [Accepted: 05/21/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Kimaya Reddy
- Department of Population Sciences, City of Hope, Duarte, CA
| | - Myo Htut
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA
| | - Amrita Krishnan
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA
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29
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Dadwal SS, Eftekhari Z, Thomas T, Munu J, Yang D, Mokhtari S, Russell A, Nakamura R. A Dynamic Machine-Learning Based Prediction Model for Sepsis in Patients Undergoing Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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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30
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Pawlowska A, Karras N, Huaying L, DiMundo J, Cheng JC, Sun W, Armenian SH, Dadwal SS, Yang D, Palmer J, Tegtmeier BR, Rosenthal J. Reactivation of Human Herpesvirus 6 (HHV6) in Pediatric Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Recipients. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.474] [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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31
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Marty FM, Ljungman P, Chemaly RF, Maertens J, Dadwal SS, Duarte RF, Haider S, Ullmann AJ, Katayama Y, Brown J, Mullane KM, Boeckh M, Blumberg EA, Einsele H, Snydman DR, Kanda Y, DiNubile MJ, Teal VL, Wan H, Murata Y, Kartsonis NA, Leavitt RY, Badshah C. Letermovir Prophylaxis for Cytomegalovirus in Hematopoietic-Cell Transplantation. N Engl J Med 2017; 377:2433-2444. [PMID: 29211658 DOI: 10.1056/nejmoa1706640] [Citation(s) in RCA: 686] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection remains a common complication after allogeneic hematopoietic-cell transplantation. Letermovir is an antiviral drug that inhibits the CMV-terminase complex. METHODS In this phase 3, double-blind trial, we randomly assigned CMV-seropositive transplant recipients, 18 years of age or older, in a 2:1 ratio to receive letermovir or placebo, administered orally or intravenously, through week 14 after transplantation; randomization was stratified according to trial site and CMV disease risk. Letermovir was administered at a dose of 480 mg per day (or 240 mg per day in patients taking cyclosporine). Patients in whom clinically significant CMV infection (CMV disease or CMV viremia leading to preemptive treatment) developed discontinued the trial regimen and received anti-CMV treatment. The primary end point was the proportion of patients, among patients without detectable CMV DNA at randomization, who had clinically significant CMV infection through week 24 after transplantation. Patients who discontinued the trial or had missing end-point data at week 24 were imputed as having a primary end-point event. Patients were followed through week 48 after transplantation. RESULTS From June 2014 to March 2016, a total of 565 patients underwent randomization and received letermovir or placebo beginning a median of 9 days after transplantation. Among 495 patients with undetectable CMV DNA at randomization, fewer patients in the letermovir group than in the placebo group had clinically significant CMV infection or were imputed as having a primary end-point event by week 24 after transplantation (122 of 325 patients [37.5%] vs. 103 of 170 [60.6%], P<0.001). The frequency and severity of adverse events were similar in the two groups overall. Vomiting was reported in 18.5% of the patients who received letermovir and in 13.5% of those who received placebo; edema in 14.5% and 9.4%, respectively; and atrial fibrillation or flutter in 4.6% and 1.0%, respectively. The rates of myelotoxic and nephrotoxic events were similar in the letermovir group and the placebo group. All-cause mortality at week 48 after transplantation was 20.9% among letermovir recipients and 25.5% among placebo recipients. CONCLUSIONS Letermovir prophylaxis resulted in a significantly lower risk of clinically significant CMV infection than placebo. Adverse events with letermovir were mainly of low grade. (Funded by Merck; ClinicalTrials.gov number, NCT02137772 ; EudraCT number, 2013-003831-31 .).
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Affiliation(s)
- Francisco M Marty
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Per Ljungman
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Roy F Chemaly
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Johan Maertens
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Sanjeet S Dadwal
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Rafael F Duarte
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Shariq Haider
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Andrew J Ullmann
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Yuta Katayama
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Janice Brown
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Kathleen M Mullane
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Michael Boeckh
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Emily A Blumberg
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Hermann Einsele
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - David R Snydman
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Yoshinobu Kanda
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Mark J DiNubile
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Valerie L Teal
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Hong Wan
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Yoshihiko Murata
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Nicholas A Kartsonis
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Randi Y Leavitt
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
| | - Cyrus Badshah
- From the Dana-Farber Cancer Institute and Brigham and Women's Hospital (F.M.M.) and Tufts Medical Center and Tufts University School of Medicine (D.R.S.), Boston; Karolinska University Hospital and Karolinska Institutet, Stockholm (P.L.); University of Texas M.D. Anderson Cancer Center, Houston (R.F.C.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (J.M.); City of Hope National Medical Center, Duarte (S.S.D.), and Stanford University School of Medicine, Palo Alto (J.B.) - both in California; Hospital Universitario Puerta de Hierro-Majadahonda, Madrid (R.F.D.); Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada (S.H.); Universitätsklinikum Würzburg, Würzburg, Germany (A.J.U., H.E.); Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima (Y. Katayama), and Saitama Medical Center, Jichi Medical University, Saitama (Y. Kanda) - both in Japan; University of Chicago, Chicago (K.M.M.); Fred Hutchinson Cancer Research Center, Seattle (M.B.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia (E.A.B.); and Merck, Kenilworth, NJ (M.J.D., V.L.T., H.W., Y.M., N.A.K., R.Y.L., C.B.)
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Ariza-Heredia EJ, Shah DP, Winston DJ, Rowley SD, Mullane KM, Chandrasekar P, Hari P, Avery RK, Peggs KS, Kumar D, Nath R, Ljungman PT, Mossad SB, Dadwal SS, Cruikshank W, Chemaly RF. The Impact of Pre- and Week 4 Post-Transplant CMV-Specific Elispot Assay on CMV Reactivation and Survival in CMV-Seropositive Allogeneic Hematopoietic Cell Transplant (Allo-HCT) Recipients. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.010] [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: 10/20/2022]
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Dadwal SS, Tegtmeier B, Liu X, Frankel P, Ito J, Forman SJ, Pullarkat V. Impact of pretransplant serum ferritin level on risk of invasive mold infection after allogeneic hematopoietic stem cell transplantation. Eur J Haematol 2014; 94:235-42. [DOI: 10.1111/ejh.12421] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Sanjeet S. Dadwal
- Division of Infectious Diseases; City of Hope Medical Center; Duarte CA USA
| | - Bernard Tegtmeier
- Division of Infectious Diseases; City of Hope Medical Center; Duarte CA USA
| | - Xueli Liu
- Division of Biostatistics; City of Hope Medical Center; Duarte CA USA
| | - Paul Frankel
- Division of Biostatistics; City of Hope Medical Center; Duarte CA USA
| | - James Ito
- Division of Infectious Diseases; City of Hope Medical Center; Duarte CA USA
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell Transplantation; City of Hope Medical Center; Duarte CA USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation; City of Hope Medical Center; Duarte CA USA
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Davies-Vorbrodt S, Ito JI, Tegtmeier BR, Dadwal SS, Kriengkauykiat J. Voriconazole serum concentrations in obese and overweight immunocompromised patients: a retrospective review. Pharmacotherapy 2013; 33:22-30. [PMID: 23307541 DOI: 10.1002/phar.1156] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY OBJECTIVE To evaluate the relationship between voriconazole dose and corresponding serum concentrations in obese and overweight immunocompromised patients. DESIGN Retrospective medical record review. SETTING National Cancer Institute-designated comprehensive cancer center. PATIENTS A total of 92 patients with hematologic malignancies and/or hematopoietic stem cell transplants who received voriconazole and had reported steady-state serum concentrations (peak, random, or trough) during 2005-2010; 124 serum concentrations were available for analysis. MEASUREMENTS AND MAIN RESULTS Data on patient demographics, voriconazole concentrations, and other clinical and safety data were collected. Patients were stratified based on body mass index (BMI). Patients with higher BMIs tended to have significantly higher median random voriconazole concentrations with intravenous administration (6.4 mg/L for BMI ≥ 25 kg/m(2) vs 2.8 mg/L for BMI < 25 kg/m(2), p=0.04). This trend was more notable with the intravenous than the oral formulations. With the oral formulation, patients with a BMI of 25 kg/m(2) or greater had a median random concentration of 2.8 mg/L compared with 2.0 mg/L in patients with a BMI less than 25 kg/m(2) (p=0.18). Patients with a BMI of 25 kg/m(2) or greater also had a higher median daily voriconazole dose (640 vs 400 mg, p<0.001). No significant differences were noted in factors that would affect oral absorption of voriconazole (e.g., graft-versus-host disease) among BMI groups. When comparing all voriconazole concentrations, higher concentrations were associated with a greater percentage of patients who had alanine aminotransferase levels of more than 3 times the upper limit of normal. Patients with voriconazole random concentrations of 2 mg/L or greater had higher response rates (50%) than patients with concentrations lower than 2 mg/L (33%). CONCLUSION Standard voriconazole dosing using actual body weight in obese and overweight patients resulted in higher associated serum concentrations. Dosing using adjusted body weight may be necessary in this population in order to achieve optimal concentrations while preventing the potential for increased toxicity.
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Abstract
Over the past 20 years, the number of invasive fungal infections has continued to persist, due primarily to the increased numbers of patients subjected to severe immunosuppression. Despite the development of more active, less toxic antifungal agents and the standard use of antifungal prophylaxis, invasive fungal infections (especially invasive mold infections) continue to be a significant factor in hematopoietic cell and solid organ transplantation outcomes, resulting in high mortality rates. Since the use of fluconazole as standard prophylaxis in the hematopoietic cell transplantation setting, invasive candidiasis has come under control, but no mold-active antifungal agent (except for posaconazole in the setting of acute myelogenous leukemia and myelodysplastic syndrome) has been shown to improve the survival rate over fluconazole. With the advent of new azole and echinocandin agents, we have seen the emergence of more azole-resistant and echinocandin-resistant fungi. The recent increase in zygomycosis seen in the hematopoietic cell transplantation setting may be due to the increased use of voriconazole. This has implications for the empiric approach to pulmonary invasive mold infections when zygomycosis cannot be ruled out. It is imperative that an amphotericin B product, an antifungal that has never developed resistance in over 50 years, be initiated. The clinical presentations of invasive mold infections and invasive candidiasis can be nonspecific and the diagnostic tests insensitive, so a high index of suspicion and immediate initiation of empiric therapy is required. Unfortunately, our currently available serologic tests do not predict infection ahead of disease, and, therefore cannot be used to initiate “preemptive” therapy. Also, the Aspergillus galactomannan test gives a false negative result in patients receiving antimold prophylaxis, ie, virtually all of our patients with hematologic malignancy and hematopoietic cell transplant recipients. We may eventually be able to select patients at highest risk for invasive fungal infections for prophylaxis by genetic testing. However, with our current armamentarium of antifungal agents and widespread use of prophylaxis in high-risk groups (hematologic malignancy, hematopoietic cell transplantation), we continue to see high incidence and mortality rates, and our future hope lies in reversing the immunosuppression or augmenting the immune system of these severely immunocompromised hosts by developing and utilizing immunotherapy, immunoprophylaxis, and vaccines.
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Abstract
Invasive fungal infections account for significant morbidity and mortality in the seriously immunocompromised host, especially those suffering from hematologic malignancies and the recipients of hematopoietic cell transplant. One of the reasons for the continuing high mortality rates due to invasive fungal infection is the delay in administering appropriate therapy. As preemptive antifungal therapy is not feasible for lack of a predictive test, early empiric therapy is currently the only approach likely to result in improvement in survival. Here, we present our approach to both invasive candidiasis and invasive mold infection. Therapy should be initiated at the first signs and symptoms of disease, utilizing knowledge of local fungal epidemiology, the patient's recent antifungal agent exposure, and the diagnostic tests immediately available, to select an appropriate antifungal agent most likely to be effective against the suspected fungal species.
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Affiliation(s)
- James I Ito
- Division of Infectious Diseases, City of Hope, Duarte, CA 91706, USA.
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Dadwal SS, Tegtmeier B, Nakamura R, Kriengkauykiat J, Ito J, Forman SJ, Pullarkat V. Nontyphoidal Salmonella infection among recipients of hematopoietic SCT. Bone Marrow Transplant 2010; 46:880-3. [PMID: 20838389 DOI: 10.1038/bmt.2010.204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The incidence of nontyphoidal Salmonella (NTS) infections is rising worldwide and several outbreaks have been reported recently. Immunosuppressed patients are particularly vulnerable to NTS infections. We retrospectively examined the clinical features and outcomes of 18 recipients of hematopoietic SCT (HSCT) who were diagnosed with NTS infection at our institution during a 15-year period. Bacteremia was the most common presenting feature and occurred in 67% of cases. Diarrhea was absent in one-third of cases. Among 12 recipients of allogeneic HSCT, 8 presented with bacteremia and only 6 had diarrhea. A total of 9 of these 12 patients had chronic GVHD. Metastatic disease was distinctly rare and occurred in only two patients, whereas one patient died of NTS sepsis. Food safety practices to prevent NTS infection are important in HSCT recipients, particularly for those who have chronic GVHD after allogeneic HSCT.
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Affiliation(s)
- S S Dadwal
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA 9100, USA.
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