1
|
Stuver R, Mian A, Brown S, Devlin S, Caimi PF, Chinapen S, Dahi P, Dean R, Epstein-Peterson ZD, Hill B, Horwitz SM, Lahoud O, Lin R, Moskowitz AJ, Sauter C, Shah G, Winter A, Jagadeesh D, Scordo M. BEAM versus pharmacokinetics-directed BuCyVP16 conditioning for patients with peripheral T-cell lymphoma undergoing high-dose therapy with autologous hematopoietic cell transplantation. Am J Hematol 2024. [PMID: 38526002 DOI: 10.1002/ajh.27291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Robert Stuver
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Agrima Mian
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samantha Brown
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sean Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Paolo F Caimi
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephanie Chinapen
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Parastoo Dahi
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert Dean
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zachary D Epstein-Peterson
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brian Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oscar Lahoud
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard Lin
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alison J Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Craig Sauter
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gunjan Shah
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alison Winter
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Scordo
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
2
|
Fingrut WB, Davis E, Archer A, Brown S, Devlin S, Chinapen S, Scaradavou A, Politikos I, Blouin AG, Shaffer BC, Barker JN. Gender disparities in allograft access due to HLA-sensitization in multiparous women. Blood Adv 2024; 8:403-406. [PMID: 38029385 PMCID: PMC10820334 DOI: 10.1182/bloodadvances.2023011893] [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] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Warren B. Fingrut
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Davis
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anne Archer
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samantha Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Chinapen
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andromachi Scaradavou
- Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Amanda G. Blouin
- Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian C. Shaffer
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Juliet N. Barker
- Bone Marrow Transplant and Cellular Therapy Program, Department of Medicine, Weill Cornell Medicine, New York, NY
| |
Collapse
|
3
|
Nath K, Peterson K, Brown S, Devlin S, Rodriguez N, Barker J, Giralt S, Gyurkocza B, Jakubowski A, Papadopoulos E, Ponce D, Scordo M, Shah G, Perales MA, Sauter C, Lin A, Dahi PB. Reduced-Intensity Compared to Nonmyeloablative Conditioning in Patients with Non-Hodgkin Lymphoma Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2024; 30:81-92. [PMID: 37788792 PMCID: PMC10842498 DOI: 10.1016/j.jtct.2023.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/05/2023]
Abstract
Reduced-intensity conditioning (RIC) and nonmyeloablative (NMA) conditioning are preferred for patients with non-Hodgkin lymphoma (NHL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT). Although prior studies have suggested that higher-intensity regimens in RIC-NMA conditioning are associated with inferior outcomes in patients with NHL, the optimal conditioning regimen remains unknown. We performed a retrospective single-center analysis to determine outcomes of adult patients with B cell and T cell NHL who underwent allo-HCT and received either RIC or NMA conditioning between March 2008 and December 2019. RIC regimens included fludarabine-cyclophosphamide-thiotepa-4 Gy-total body irradiation (Flu-Cy-TT-4Gy-TBI), fludarabine-melphalan (Flu-Mel), fludarabine-cyclophosphamide-4 Gy-total body irradiation (Flu-Cy-4Gy-TBI), and fludarabine-busulfan-4 (Flu-Bu-4). The NMA regimen comprised fludarabine-cyclophosphamide-2 Gy-total body irradiation (Flu-Cy-2Gy-TBI). The primary outcome was overall survival (OS); secondary outcomes included progression-free survival (PFS), nonrelapse mortality (NRM), and the incidence of acute and chronic graft-versus-host-disease (GVHD). Of 279 transplants recipients (median age, 58 years), 110 received RIC (55% Flu-Mel, 38% Flu-Cy-TT-4Gy-TBI, 6% Flu-Bu-4, 1% Flu-Cy-4Gy-TBI) and 169 received NMA conditioning with Flu-Cy-2Gy-TBI. With a median of 64 months of follow-up post-allo-HCT, there was no significant difference in OS between the NMA and RIC groups (median, not reached [NR] versus 103 months; P = .1), and this was maintained on multivariable analysis. Similarly, after adjustment for all independently significant covariates (age, Karnofsky Performance Status [KPS], Hematopoietic Cell Transplantation Comorbidity Index [HCT-CI], and disease histology), the regression analysis showed no significant difference in PFS with RIC compared to NMA conditioning (hazard ratio [HR] 1.38; 95% confidence interval [CI], .92 to 2.09; P = .24). On univariable analysis, there was no significant difference in NRM between the RIC and NMA arms (100-day estimate, 10.0% versus 1.8%; P = .5). After adjustment for age, ethnicity, KPS, HCT-CI, GVHD prophylaxis, and donor source, RIC conditioning was associated with a significantly higher incidence of NRM compared to NMA conditioning (HR, 2.61; 95% CI, 1.04 to 6.52; P = .039). On multivariable analysis, compared with the NMA arm, the RIC arm had higher rates of grade II-IV (HR, 2.25; 95% CI, 1.31 to 3.86; P = .002) and grade III-IV acute GVHD (HR, 5.62; 95% CI, 2.03 to 15.6; P < .001). The findings of this study suggest that NMA conditioning with Flu-Cy-TBI-2Gy may be considered over more intensive RIC regimens for patients with NHL undergoing allo-HCT.
Collapse
Affiliation(s)
- Karthik Nath
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Samantha Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Natasia Rodriguez
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juliet Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio Giralt
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Boglarka Gyurkocza
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ann Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Esperanza Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Doris Ponce
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Michael Scordo
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gunjan Shah
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Miguel-Angel Perales
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig Sauter
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrew Lin
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Parastoo B Dahi
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| |
Collapse
|
4
|
Infante MS, Nemirovsky D, Devlin S, DeWolf S, Tamari R, Dahi PB, Lee YJ, Chung DJ, Politikos I, Barker J, Giralt SA, Babady NE, Ramanathan L, Papanicolaou GA, Seo S, Kamboj M, Perales MA, Shah GL. Outcomes and Management of the SARS-CoV2 Omicron Variant in Recipients of Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2024; 30:116.e1-116.e12. [PMID: 37806446 DOI: 10.1016/j.jtct.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
Hematopoietic cell transplantation (HCT) and chimeric antigen receptor T cell therapy (CAR-T) recipients who develop Coronavirus disease 2019 (COVID-19) can have decreased overall survival (OS), likely due to disease-inherent and therapy-related immunodeficiency. The availability of COVID-19-directed therapies and vaccines have improved COVID-19-related outcomes, but immunocompromised individuals remain vulnerable. Specifically, the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant infections, including Omicron and its sublineages, particularly in HCT recipients, remain to be defined. The aim of this study was to compare the impact of SARS-CoV-2 Omicron infections in HCT/CAR-T recipients with outcomes previously reported for ancestral SARS-CoV-2 infections early in the pandemic (March to June 2020). This was a retrospective analysis of adult HCT/CAR-T recipients diagnosed with COVID-19 at Memorial Sloan Kettering Cancer Center between July 2021 and July 2022. We identified 353 patients (172 autologous HCT recipients [49%], 152 allogeneic HCT recipients [43%], and 29 CAR-T recipients [8%]), with a median time from HCT/CAR-T to SARS-CoV-2 infection of 1010 days (interquartile range, 300 to 2046 days). Forty-one patients (12%) were diagnosed with COVID-19 during the delta wave, and 312 patients (88%) were diagnosed during the Omicron wave. Risk factors associated with increased odds of COVID-19-related hospitalization were the presence of 2 or more comorbidities (odds ratio [OR], 4.9; 95% confidence interval [CI], 2.4 to 10.7; P < .001), CAR-T therapy compared to allogeneic HCT (OR, 7.7; 95% CI, 3.0 to 20.0; P < .001), hypogammaglobulinemia (OR, 2.71; 95% CI, 1.06 to 6.40; P = .027), and age at COVID-19 diagnosis (OR, 1.03; 95% CI, 1.0 to 1.05; P = .04). In contrast, infection during the Omicron variant BA5/BA4-dominant period compared to variant BA1 (OR, .21; 95% CI, .03 to .73; P = .037) and more than 3 years from HCT/CAR-T therapy to COVID-19 diagnosis compared to early infection at <100 days (OR, .31; 95% CI, .12 to .79; P = .011) were associated with a decreased odds for hospitalization. The OS at 12 months from COVID-19 diagnosis was 89% (95% CI, 84% to 94%), with 6 of 26 deaths attributable to COVID-19. Patients with the ancestral strain of SAR-CoV-2 had a lower OS at 12 months, with 73% (95% CI, 62% to 84%) versus 89% (95% CI, 84% to 94%; P < .001) in the Omicron cohort. Specific COVID-19 treatment was administered in 62% of patients, and 84% were vaccinated with mRNA COVID-19 vaccines. Vaccinated patients had significantly better OS than unvaccinated patients (90% [95% CI, 86% to 95%] versus 82% [95% CI, 72% to 94%] at 12 months; P = .003). No significant difference in OS was observed in patients infected with the Omicron and those infected with the Delta variant (P = .4) or treated with specific COVID-19 treatments compared with those not treated (P = .2). We observed higher OS in HCT and CAR-T recipients infected with the Omicron variants compared to those infected with the ancestral strain of SARS-CoV2. The use of COVID-19 antivirals, mAbs, and vaccines might have contributed to the improved outcomes.
Collapse
Affiliation(s)
- Maria-Stefania Infante
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; University Hospital Infanta Leonor, Madrid, Spain.
| | - David Nemirovsky
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan DeWolf
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Parastoo B Dahi
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yeon Joo Lee
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Juliet Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - N Esther Babady
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial SLoan Kettering Cancer Center, New York, New York
| | - Lakshmi Ramanathan
- Clinical Chemistry Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Genovefa A Papanicolaou
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan Seo
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mini Kamboj
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| |
Collapse
|
5
|
Cho C, Devlin S, Maloy M, Horowitz MM, Logan B, Rizzo JD, Giralt SA, Perales MA. Application of the CIBMTR One Year Survival Outcomes Calculator as a tool for retrospective analysis. Bone Marrow Transplant 2023; 58:1089-1095. [PMID: 37422574 PMCID: PMC10592419 DOI: 10.1038/s41409-023-02031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
The Web-based One Year Survival Outcomes Calculator developed by the Center for International Blood and Marrow Transplant Research (CIBMTR) applies large-scale registry data to generate individualized estimates of overall survival (OS) probability 1 year after first allogeneic hematopoietic cell transplant (HCT) and can therefore provide a data-driven foundation for personalized patient counseling. We assessed the calibration of the CIBMTR One Year Survival Outcomes Calculator when applied to retrospective data among adult recipients of first allogeneic HCT for acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or myelodysplastic syndrome (MDS) with peripheral blood stem cell transplant (PBSCT) from a 7/8- or 8/8-matched donor from 2000 through 2015 at a single center. Predicted 1 year OS was estimated for each patient using the CIBMTR Calculator. Corresponding observed 1 year OS was estimated for each group by the Kaplan-Meier method. A weighted Kaplan-Meier estimator was used to visually display the average of observed 1 year survival estimates over the continuous range of predicted OS. In the first analysis of its kind, we demonstrated that the CIBMTR One Year Survival Outcomes Calculator could be applied to larger patient cohorts and predicted 1 year prognosis with general agreement between predicted and observed survival.
Collapse
Affiliation(s)
- Christina Cho
- Department of Medicine, Stem Cell Transplantation and Cellular Therapy Service, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sean Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Molly Maloy
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary M Horowitz
- Medical College of Wisconsin and Center for International Blood and Marrow Transplant Research, Milwaukee, WI, USA
| | - Brent Logan
- Medical College of Wisconsin and Center for International Blood and Marrow Transplant Research, Milwaukee, WI, USA
| | - J Douglas Rizzo
- Medical College of Wisconsin and Center for International Blood and Marrow Transplant Research, Milwaukee, WI, USA
| | - Sergio A Giralt
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | |
Collapse
|
6
|
Park JH, Devlin S, Durham BH, Winer ES, Huntington S, von Keudell G, Vemuri S, Shukla M, Falco V, Cuello B, Gore S, Stone R, Abdel-Wahab O, Tallman MS. Vemurafenib and Obinutuzumab as Frontline Therapy for Hairy Cell Leukemia. NEJM Evid 2023; 2:EVIDoa2300074. [PMID: 38320179 DOI: 10.1056/evidoa2300074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Vemurafenib and Obinutuzumab for Hairy Cell LeukemiaIn this study of vemurafenib plus obinutuzumab of patients with previously untreated hairy cell leukemia, treatment was administered for four cycles, and the primary end point was complete remission rate. Twenty-seven of 30 patients completed all four cycles of treatment and achieved complete remission. No dose-limiting toxicity was observed.
Collapse
Affiliation(s)
- Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
- Department of Medicine, Weill Cornell Medicine, New York
| | - Sean Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Benjamin H Durham
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Eric S Winer
- Leukemia Service, Department of Medicine, Dana-Farber Cancer Institute, Boston
| | | | | | - Shreya Vemuri
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Madhulika Shukla
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Victoria Falco
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Bernadette Cuello
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Steven Gore
- Yale Cancer Center, New Haven, CT
- National Cancer Institute, Bethesda, MD
| | - Richard Stone
- Leukemia Service, Department of Medicine, Dana-Farber Cancer Institute, Boston
| | - Omar Abdel-Wahab
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
- Molecular Pharmacology Program, Sloan Kettering Institute, New York
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
- Department of Medicine, Northwestern Comprehensive Cancer Center, Chicago
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago
| |
Collapse
|
7
|
Tamari R, Scordo M, Kunvarjee BM, Proli A, Lin A, Flynn J, Cho C, Devlin S, Klein E, Boulad F, Cancio MI, Curran KJ, Jakubowski AA, Kernan NA, Kung AL, O’Reilly RJ, Papadopoulos EB, Prockop S, Scaradavou A, Shaffer BC, Shah G, Spitzer B, Gyurkocza B, Giralt SA, Perales MA, Boelens JJ. Association between busulfan exposure and survival in patients undergoing a CD34+ selected stem cell transplantation. Blood Adv 2023; 7:5225-5233. [PMID: 37379285 PMCID: PMC10500467 DOI: 10.1182/bloodadvances.2023009708] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
Busulfan is an alkylating drug routinely used in conditioning regimens for allogeneic hematopoietic cell transplantation (allo-HCT). A myeloablative conditioning regimen, including busulfan, is commonly used in patients undergoing T-cell depletion (TCD) and allo-HCT, but data on optimal busulfan pharmacokinetic (PK) exposure in this setting are limited. Between 2012 and 2019, busulfan PK was performed to target an area under the curve exposure between 55 and 66 mg × h/L over 3 days using a noncompartmental analysis model. We retrospectively re-estimated busulfan exposure following the published population PK (popPK) model (2021) and correlated it with outcomes. To define optimal exposure, univariable models were performed with P splines, wherein hazard ratio (HR) plots were drawn, and thresholds were found graphically as the points at which the confidence interval crossed 1. Cox proportional hazard and competing risk models were used for analyses. 176 patients were included, with a median age of 59 years (range, 2-71). Using the popPK model, the median cumulative busulfan exposure was 63.4 mg × h/L (range, 46.3-90.7). The optimal threshold was at the upper limit of the lowest quartile (59.5 mg × h/L). 5-year overall survival (OS) with busulfan exposure ≥59.5 vs <59.5 mg × h/L was 67% (95% CI, 59-76) vs 40% (95% CI, 53-68), respectively (P = .02), and this association remained in a multivariate analyses (HR, 0.5; 95% CI, 0.29; 0.88; P = .02). In patients undergoing TCD allo-HCT, busulfan exposure is significantly associated with OS. The use of a published popPK model to optimize exposure may significantly improve the OS.
Collapse
Affiliation(s)
- Roni Tamari
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Michael Scordo
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Binni M. Kunvarjee
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Andrew Lin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Flynn
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Cho
- Stem Cell Transplantion and Cellular Therapy Program, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Sean Devlin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth Klein
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Farid Boulad
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Maria I. Cancio
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Kevin J. Curran
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Ann A. Jakubowski
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Nancy A. Kernan
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Andrew L. Kung
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Richard J. O’Reilly
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Esperanza B. Papadopoulos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Susan Prockop
- Department of Pediatrics, Boston Children’s Hospital and Dana Farber Cancer Institute, Boston, MA
| | - Andromachi Scaradavou
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Brian C. Shaffer
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Gunjan Shah
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Barbara Spitzer
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Boglarka Gyurkocza
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sergio A. Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Jaap Jan Boelens
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| |
Collapse
|
8
|
Fingrut WB, Gyurkocza B, Flynn J, Davis E, Devlin S, Scaradavou A, Chinapen S, Quach S, Cho C, Giralt SA, Jakubowski AA, Lin RJ, Papadopoulos EB, Perales MA, Ponce D, Shaffer BC, Tamari R, Young JW, Politikos I, Barker JN. Analysis of disparities in time to allogeneic transplantation in adults with acute myelogenous leukemia. Blood Adv 2023; 7:3824-3833. [PMID: 36240477 PMCID: PMC10393759 DOI: 10.1182/bloodadvances.2022008572] [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: 07/15/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/20/2022] Open
Abstract
Although alternative donors extend transplant access, whether recipient ancestry affects the time to allogeneic transplant is not established. We analyzed the likelihood of clinically significant delays to allograft by patient ancestry in 313 adult patients with acute myelogenous leukemia (AML) who underwent transplantation. Non-European ancestry patients (n = 99) were more likely than Europeans (n = 214) to receive HLA-mismatched donor allografts (45% vs 24%). Overall, the median time from transplant indication to allograft was 127 days (range, 57-1683). In multivariable analysis, non-Europeans had an increased risk of prolonged indication to transplant time >180 days owing to significant delays in indication to consult >90 days and consult to transplant >120 days. Compared with recipients of HLA-matched unrelated donors (URDs), HLA-mismatched adult donor recipients were at an increased risk of delayed indication to transplant, whereas HLA-identical sibling and cord blood recipients were at a lower risk. Subanalysis showed more indication to transplant delays >180 days in non-European (44%) vs European (19%) 8/8 URD recipients. Finally, the pandemic further exacerbated delays for non-Europeans. In summary, although non-European patients with AML are less likely to receive 8/8 URDs as expected, if they do, their transplants are delayed. HLA-identical siblings and cord blood facilitate the fastest transplants regardless of patient ancestry, whereas other adult donor transplants are delayed. Strategies to mitigate referral barriers, hasten donor evaluation, and use all alternative donor sources are critical to ensure timely transplantation for patients with AML.
Collapse
Affiliation(s)
- Warren B. Fingrut
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Boglarka Gyurkocza
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Davis
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andromachi Scaradavou
- Pediatric Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Chinapen
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean Quach
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Cho
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Sergio A. Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Ann A. Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Richard J. Lin
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Esperanza B. Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Doris Ponce
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Brian C. Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - James W. Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Juliet N. Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| |
Collapse
|
9
|
Sanchez-Escamilla M, Flynn J, Devlin S, Maloy M, Fatmi SA, Tomas AA, Escribano-Serrat S, Ponce D, Sauter CS, Giralt SA, Scordo M, Perales MA. EASIX score predicts inferior survival after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2023; 58:498-505. [PMID: 36721042 PMCID: PMC10513445 DOI: 10.1038/s41409-023-01922-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/11/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Abstract
The Endothelial Activation and Stress Index (EASIX) is a prognostic tool that uses common clinical laboratory values and has been shown to predict non-relapse mortality (NRM) and overall survival (OS) at the onset of acute graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (HCT). We hypothesized that EASIX calculated at different time points pre- and post- HCT may predict NRM and OS, and that EASIX calculated at onset of GVHD may predict response to steroids. We evaluated the EASIX score pre- and post-HCT in 152 patients with lymphoid malignancies undergoing unmodified reduced intensity conditioning (RIC) alloHCT with uniform GVHD prophylaxis. In multivariate analysis, EASIX calculated pre-HCT was significantly associated with higher NRM (HR = 1.64, p = 0.009) and lower OS (HR = 1.33, p = 0.046). Furthermore, EASIX calculated at day 30 and at day 100 was associated with increased NRM (HR = 1.65, p < 0.001; and HR = 1.65, p < 0.001) and decreased OS (HR = 1.27, p = 0.018; and HR = 1.49, p < 0.001), independent of HCT-CI, disease and conditioning regimen. Our study shows that high EASIX scores at various time points pre- and post-HCT are significantly associated with poorer overall outcomes. EASIX provides an independent and easily accessible tool to predict outcomes that can be complementary to other measures of risk stratification for patients undergoing HCT.
Collapse
Affiliation(s)
- Miriam Sanchez-Escamilla
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Department of Hematological Malignancies and Stem Cell Transplantation, Research Institute of Marques de Valdecilla (IDIVAL), Santander, Spain.
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Molly Maloy
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Samira A Fatmi
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ana Alarcon Tomas
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Silvia Escribano-Serrat
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Doris Ponce
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Craig S Sauter
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Sergio A Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Michael Scordo
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, 10065, USA.
| |
Collapse
|
10
|
Feldman S, Gupta D, Navi BB, Grace Ho KW, Willeit P, Devlin S, Bolton KL, Arcila ME, Mantha S. Tumor Genomic Profile Is Associated With Arterial Thromboembolism Risk in Patients With Solid Cancer. JACC CardioOncol 2023; 5:246-255. [PMID: 37144118 PMCID: PMC10152200 DOI: 10.1016/j.jaccao.2023.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 05/06/2023] Open
Abstract
Background Patients with cancer have an increased risk for arterial thromboembolism (ATE). Scant data exist about the impact of cancer-specific genomic alterations on the risk for ATE. Objectives The aim of this study was to determine whether individual solid tumor somatic genomic alterations influence the incidence of ATE. Methods A retrospective cohort study was conducted using tumor genetic alteration data from adults with solid cancers who underwent Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets testing between 2014 and 2016. The primary outcome, ATE, was defined as myocardial infarction, coronary revascularization, ischemic stroke, peripheral arterial occlusion, or limb revascularization and identified through systematic electronic medical record assessments. Patients were followed from date of tissue-matched blood control accession to first ATE event or death, for up to 1 year. Cause-specific Cox proportional hazards regression was used to determine HRs of ATE for individual genes adjusted for pertinent clinical covariates. Results Among 11,871 eligible patients, 74% had metastatic disease, and there were 160 ATE events. A significantly increased risk for ATE independent of tumor type was noted for the KRAS oncogene (HR: 1.98; 95% CI: 1.34-2.94; multiplicity-adjusted P = 0.015) and the STK11 tumor suppressor gene (HR: 2.51; 95% CI: 1.44-4.38; multiplicity-adjusted P = 0.015). Conclusions In a large genomic tumor-profiling registry of patients with solid cancers, alterations in KRAS and STK11 were associated with an increased risk for ATE independent of cancer type. Further investigation is needed to elucidate the mechanism by which these mutations contribute to ATE in this high-risk population.
Collapse
Affiliation(s)
- Stephanie Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dipti Gupta
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Babak B. Navi
- Department of Neurology and the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ka-Wai Grace Ho
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Peter Willeit
- Clinical Epidemiology Team, Medical University of Innsbruck, Innsbruck, Austria
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kelly L. Bolton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria E. Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Simon Mantha
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Address for correspondence: Dr Simon Mantha, Memorial Sloan Kettering Cancer Center, Koch Center, 530 East 74th Street, New York, New York 10021, USA.
| |
Collapse
|
11
|
Hubbeling H, Silverman EA, Michaud L, Tomas AA, Shouval R, Flynn J, Devlin S, Wijetunga NA, Tringale KR, Batlevi C, Dahi P, Giralt S, Lin R, Park J, Scordo M, Sauter C, Shah G, Hajj C, Salles G, Schoder H, Palomba ML, Perales MA, Yahalom J, Imber BS. Bridging Radiation Rapidly and Effectively Cytoreduces High-Risk Relapsed/Refractory Aggressive B Cell Lymphomas Prior to Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2023; 29:259.e1-259.e10. [PMID: 36587744 PMCID: PMC10089652 DOI: 10.1016/j.jtct.2022.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/29/2022] [Revised: 11/22/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
Greater tumor burden before CD19-targeted chimeric antigen receptor T cell (CAR-T) therapy predicts lower complete response rate and shorter overall survival (OS) in patients with aggressive non-Hodgkin lymphoma (NHL). Recent patterns of failure studies have identified lesion characteristics, including size, standard uptake value (SUV), and extranodal location, as associated with post-CAR-T therapy failure. Here we analyzed the effect of bridging radiation-containing treatment (BRT) on pre-CAR-T therapy lesion- and patient-level characteristics and post-CAR-T therapy outcomes, including patterns of failure. Consecutive NHL patients who received radiation therapy from 30 days before leukapheresis until CAR T cell infusion were reviewed. Metabolic tumor volume (MTV) was contoured with a threshold SUV of 4. The first post-CAR-T therapy failures were categorized as preexisting/new/mixed with respect to pre-CAR-T therapy disease and in-field/marginal/distant with respect to BRT. Forty-one patients with diffuse large B cell lymphoma (DLBCL; n = 33), mantle cell lymphoma (n = 7), or Burkitt lymphoma (n = 1) were identified. BRT significantly improved established high-risk parameters of post-CAR-T therapy progression, including in-field median MTV (45.5 cc to .2 cc; P < .001), maximum SUV (18.1 to 4.4; P < .001), diameter (5.5 cm to 3.2 cm; P < .001), and lactate dehydrogenase (LDH; 312 to 232; P = .025). DLBCL patients with lower LDH levels post-BRT had improved progression-free survival (PFS; P = .001). In DLBCL, first failures were new in 7 of 19 patients, preexisting in 5 of 19, and mixed in 7 of 19; with respect to BRT, 4 of 19 were in-field and 4 of 19 were marginal. Post-CAR-T therapy survival was similar in patients with initially low MTV and those with newly low MTV post-BRT using a statistically determined threshold of 16 cc (PFS, 26 months versus 31 months; OS unreached for both). BRT produced significant cytoreductions in diameter, SUV, MTV, and LDH, all predictors of poor post-CAR-T therapy outcomes. Similar PFS and OS in patients with initially low MTV and those who achieved newly low MTV after BRT suggest that BRT may "convert" poor-risk patients to better risk. In the future, the response to BRT may allow for risk stratification and individualization of bridging strategies.
Collapse
Affiliation(s)
- Harper Hubbeling
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily A Silverman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laure Michaud
- Department of Radiology, Molecular Imaging, and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ana Alarcon Tomas
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roni Shouval
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica Flynn
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - N Ari Wijetunga
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn R Tringale
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Connie Batlevi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Parastoo Dahi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard Lin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jae Park
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Scordo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Craig Sauter
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gunjan Shah
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carla Hajj
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heiko Schoder
- Department of Radiology, Molecular Imaging, and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - M Lia Palomba
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel-Angel Perales
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brandon S Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
| |
Collapse
|
12
|
Ponce DM, Alousi AM, Nakamura R, Slingerland J, Calafiore M, Sandhu KS, Barker JN, Devlin S, Shia J, Giralt S, Perales MA, Moore G, Fatmi S, Soto C, Gomes A, Giardina P, Marcello L, Yan X, Tang T, Dreyer K, Chen J, Daley WL, Peled JU, van den Brink MRM, Hanash AM. A phase 2 study of interleukin-22 and systemic corticosteroids as initial treatment for acute GVHD of the lower GI tract. Blood 2023; 141:1389-1401. [PMID: 36399701 PMCID: PMC10163318 DOI: 10.1182/blood.2021015111] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 01/10/2022] [Revised: 10/12/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022] Open
Abstract
Graft-versus-host disease (GVHD) is a major cause of morbidity and mortality following allogeneic hematopoietic transplantation. In experimental models, interleukin-22 promotes epithelial regeneration and induces innate antimicrobial molecules. We conducted a multicenter single-arm phase 2 study evaluating the safety and efficacy of a novel recombinant human interleukin-22 dimer, F-652, used in combination with systemic corticosteroids for treatment of newly diagnosed lower gastrointestinal acute GVHD. The most common adverse events were cytopenias and electrolyte abnormalities, and there were no dose-limiting toxicities. Out of 27 patients, 19 (70%; 80% confidence interval, 56%-79%) achieved a day-28 treatment response, meeting the prespecified primary endpoint. Responders exhibited a distinct fecal microbiota composition characterized by expansion of commensal anaerobes, which correlated with increased overall microbial α-diversity, suggesting improvement of GVHD-associated dysbiosis. This work demonstrates a potential approach for combining immunosuppression with tissue-supportive strategies to enhance recovery of damaged mucosa and promote microbial health in patients with gastrointestinal GVHD. This trial was registered at www.clinicaltrials.gov as NCT02406651.
Collapse
Affiliation(s)
- Doris M. Ponce
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College; New York, NY
| | - Amin M. Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ryotaro Nakamura
- Hematologic Malignancies and Stem Cell Transplantation Institute, City of Hope National Medical Center, Duarte, CA
| | - John Slingerland
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marco Calafiore
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karamjeet S. Sandhu
- Hematologic Malignancies and Stem Cell Transplantation Institute, City of Hope National Medical Center, Duarte, CA
| | - Juliet N. Barker
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College; New York, NY
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College; New York, NY
| | - Miguel-Angel Perales
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College; New York, NY
| | - Gillian Moore
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samira Fatmi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cristina Soto
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Antonio Gomes
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Giardina
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - LeeAnn Marcello
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Xiaoqiang Yan
- Evive Biotechnology (Shanghai) Ltd (formerly Generon [Shanghai] Corporation Ltd), Shanghai, China
| | - Tom Tang
- Evive Biotechnology (Shanghai) Ltd (formerly Generon [Shanghai] Corporation Ltd), Shanghai, China
| | - Kevin Dreyer
- Evive Biotechnology (Shanghai) Ltd (formerly Generon [Shanghai] Corporation Ltd), Shanghai, China
| | - Jianmin Chen
- Evive Biotechnology (Shanghai) Ltd (formerly Generon [Shanghai] Corporation Ltd), Shanghai, China
| | - William L. Daley
- Evive Biotechnology (Shanghai) Ltd (formerly Generon [Shanghai] Corporation Ltd), Shanghai, China
| | - Jonathan U. Peled
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College; New York, NY
| | - Marcel R. M. van den Brink
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College; New York, NY
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alan M. Hanash
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College; New York, NY
- Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
13
|
St-Pierre J, Rosentreter R, Kiraly A, Hart Szostakiwskyj J, Novak K, Panaccione R, Kaplan G, Devlin S, Seow C, Ingram R, Ma C, Wilson S, Medellin A, Lu C. A192 EFFICACY OF USTEKINUMAB IN SMALL BOWEL STRICTURES OF FIBROSTENOTIC CROHN'S DISEASE AS ASSESSED BY INTESTINAL ULTRASOUND. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991175 DOI: 10.1093/jcag/gwac036.192] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Small bowel Crohn’s disease (CD) strictures can lead to debilitating obstructive symptoms and the deterioration of quality of life. Imaging modalities such as intestinal ultrasound (IUS) are invaluable in the diagnosis of strictures. The use of IUS in CD is rapidly growing, is cost-effective, easily repeatable, and similar in accuracy to magnetic resonance enterography. Evidence for medical management of fibrostenotic CD has been limited to anti-tumor necrosis factor biologics. Studies on the efficacy of other biologic therapies for strictures such as ustekinumab, a p40/interleukin 12 and 23 inhibitor, are lacking. Purpose The objective of this study was to evaluate the efficacy of ustekinumab in the treatment of small bowel strictures on IUS. Method This retrospective cohort study evaluated the IUS changes of terminal ileal (TI) CD strictures at baseline and 12 months following ustekinumab initiation from 2016 to 2020 at a single tertiary care center. Strictures identified were defined as 1) increased bowel wall thickness (BWT) > 3mm, 2) narrowed luminal apposition, and 3) presence of pre-stenotic dilation (PSD) or the inability to pass the colonoscope through the narrowed area. Changes in sonographic parameters (BWT, luminal size, PSD, length, hyperemia, inflammatory fat, dysfunctional peristalsis) were recorded at baseline prior to initiation of ustekinumab and compared 12 months after treatment. Differences from baseline to 12 months were paired within-person and statistical analysis was performed using paired T-tests for continuous variables and McNemar’s test for categorical variables. Result(s) Of the 18 patients identified, 55% (n = 10) were male, median age was 49 years (Q1-Q3: 33-63 years) at initial scan, with median CD duration of 10 years (Q1-Q3: 8-20 years). The majority of TI strictures were surgically naïve (67%, n = 12). Between pre- and 12-month post ustekinumab therapy scans, there was significant improvement in BWT [8.2 mm vs 7.2 mm, p = 0.048], however there was no significant difference in the presence of peri-enteric inflammatory fat (p = 0.10), mean stricture length (17.7 vs 21.7 cm, p = 0.18), and mean stricture lumen diameter (3.3 mm vs 2.7 mm, p = 0.44) (Table 1). There was also no significant difference in the presence of stricture-associated peri-enteric fat (89% vs 67%, p = 0.10), stricture-associated hyperemia (83% vs 89%, p = 0.65) or dysfunctional peristalsis (50% vs 61%, p = 0.41) (Table 1). Image ![]()
Conclusion(s) Our study is the first to report the efficacy of ustekinumab in small bowel CD strictures using IUS at baseline and 12 months. This study shows that although ustekinumab leads to improvement in overall sonographic appearance of bowel thickness, it does not improve luminal narrowing nor PSD, two hallmark criteria of fibrostenosis. More extensive studies with larger sample sizes evaluating ustekinumab, or combination therapies, are required to identify their role in stricturing CD. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Collapse
Affiliation(s)
| | | | | | - J Hart Szostakiwskyj
- Methods and Analytics, Clinical Research Unit, University of Calgary, Calgary, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Elko TA, Brown S, Lobaugh S, Devlin S, Jakubowski AA, Perales MA, Maloy MA, Applebaum AJ, Giralt SA, Levy L, Schneider A, Lin RJ. Characteristics of Distress and Support Group Participation in Caregivers of Older Allogeneic Hematopoietic Cell Transplantation Patients: A Single Institution Retrospective Review. J Adv Pract Oncol 2023; 14:127-137. [PMID: 37009407 PMCID: PMC10062532 DOI: 10.6004/jadpro.2023.14.2.3] [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: 04/03/2023] Open
Abstract
Older patients with hematologic malignancies are increasingly considered for allogeneic hematopoietic cell transplant (allo-HCT). However, older patients often have increased comorbidities and thus may require an increased level of post-transplant care. These factors can contribute to increased caregiver distress, which has been associated with worsened health outcomes for caregivers and patients. To examine predictors of caregiver distress and support group participation in caregivers of older allo-HCT patients, we retrospectively reviewed charts of 208 patients aged 60 and older who underwent their first allo-HCT at our institution from 2014 through 2016. We systematically characterized and identified the incidence of caregiver distress and attendance in a caregiver support group from the start of conditioning through 1 year post allo-HCT. Evidence of caregiver distress and support group participation was recorded by reviewing clinical and/or social work documentation. We found that 20 caregivers (10%) endorsed stress and 44 caregivers (21%) attended our support group at least once. A patient's prior history of psychiatric diagnosis (p = .046) or the use of potentially inappropriate medications for older adults (p = .046) was found to be associated with caregiver stress. Caregivers who were spouses or partners of patients (p = .048) or caregivers of married patients were more likely to attend the support group (p = .007). While limited by retrospective design and likely underreporting, this study reveals factors associated with caregiver distress in the older allo-HCT caregiver population. This information can help providers identify caregivers at risk for distress and improve caregiver resources, which may improve both caregiver and patient outcomes.
Collapse
Affiliation(s)
- Theresa A. Elko
- From Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samantha Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephanie Lobaugh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ann A. Jakubowski
- From Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Miguel-angel Perales
- From Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Molly A. Maloy
- From Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allison J. Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio A. Giralt
- From Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Lauren Levy
- From Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Schneider
- Department of Social Work, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J. Lin
- From Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| |
Collapse
|
15
|
Shah UA, Whiting K, Devlin S, Ershler R, Kanapuru B, Lee DJ, Tahri S, Gwise T, Rustad EH, Mailankody S, Lesokhin AM, Kazandjian D, Maura F, Auclair D, Birmann BM, Usmani SZ, Gormley N, Marinac CR, Landgren O. Extreme body mass index and survival in newly diagnosed multiple myeloma patients. Blood Cancer J 2023; 13:13. [PMID: 36631444 PMCID: PMC9834289 DOI: 10.1038/s41408-022-00782-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA.
| | - Karissa Whiting
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 1275 York Avenue, New York, NY, 10065, USA
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 1275 York Avenue, New York, NY, 10065, USA
| | - Rachel Ershler
- Division of Hematologic Malignancies II, Center for Drug Evaluation and Research, U.S. Food, and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - Bindu Kanapuru
- Division of Hematologic Malignancies II, Center for Drug Evaluation and Research, U.S. Food, and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - David J Lee
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Sabrin Tahri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Hematology, Erasmus University Medical Center, 3000CA, Rotterdam, The Netherlands
| | - Thomas Gwise
- Division of Biometrics IX, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - Even H Rustad
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital Radiumhospitalet, 0379, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Hospital, 0456, Oslo, Norway
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA
| | - Alexander M Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA
| | - Dickran Kazandjian
- Department of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami, 1475 NW 12th Avenue, Miami, FL, 33136, USA
| | - Francesco Maura
- Department of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami, 1475 NW 12th Avenue, Miami, FL, 33136, USA
| | - Daniel Auclair
- Multiple Myeloma Research Foundation, 383 Main Avenue #5, Norwalk, CT, 06851, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA
| | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA
| | - Nicole Gormley
- Division of Hematologic Malignancies II, Center for Drug Evaluation and Research, U.S. Food, and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - Catherine R Marinac
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Ola Landgren
- Department of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami, 1475 NW 12th Avenue, Miami, FL, 33136, USA
| |
Collapse
|
16
|
Stahl M, Derkach A, Farnoud N, Bewersdorf JP, Robinson T, Famulare C, Cho C, Devlin S, Menghrajani K, Patel MA, Cai SF, Miles LA, Bowman RL, Geyer MB, Dunbar A, Epstein-Peterson ZD, McGovern E, Schulman J, Glass JL, Taylor J, Viny AD, Stein EM, Getta B, Arcila ME, Gao Q, Barker J, Shaffer BC, Papadopoulos EB, Gyurkocza B, Perales MA, Abdel-Wahab O, Levine RL, Giralt SA, Zhang Y, Xiao W, Pai N, Papaemmanuil E, Tallman MS, Roshal M, Goldberg AD. Molecular predictors of immunophenotypic measurable residual disease clearance in acute myeloid leukemia. Am J Hematol 2023; 98:79-89. [PMID: 36251406 PMCID: PMC10080561 DOI: 10.1002/ajh.26757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Measurable residual disease (MRD) is a powerful prognostic factor in acute myeloid leukemia (AML). However, pre-treatment molecular predictors of immunophenotypic MRD clearance remain unclear. We analyzed a dataset of 211 patients with pre-treatment next-generation sequencing who received induction chemotherapy and had MRD assessed by serial immunophenotypic monitoring after induction, subsequent therapy, and allogeneic stem cell transplant (allo-SCT). Induction chemotherapy led to MRD- remission, MRD+ remission, and persistent disease in 35%, 27%, and 38% of patients, respectively. With subsequent therapy, 34% of patients with MRD+ and 26% of patients with persistent disease converted to MRD-. Mutations in CEBPA, NRAS, KRAS, and NPM1 predicted high rates of MRD- remission, while mutations in TP53, SF3B1, ASXL1, and RUNX1 and karyotypic abnormalities including inv (3), monosomy 5 or 7 predicted low rates of MRD- remission. Patients with fewer individual clones were more likely to achieve MRD- remission. Among 132 patients who underwent allo-SCT, outcomes were favorable whether patients achieved early MRD- after induction or later MRD- after subsequent therapy prior to allo-SCT. As MRD conversion with chemotherapy prior to allo-SCT is rarely achieved in patients with specific baseline mutational patterns and high clone numbers, upfront inclusion of these patients into clinical trials should be considered.
Collapse
Affiliation(s)
- Maximilian Stahl
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medical Oncology, Division of Leukemia, Dana-Farber Cancer Institute, Boston, MA
| | - Andriy Derkach
- Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Noushin Farnoud
- Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jan Philipp Bewersdorf
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Troy Robinson
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Gerstner Sloan Kettering Graduate School of Biomedical Sciences, New York, NY
| | - Christopher Famulare
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Cho
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Sean Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kamal Menghrajani
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Minal A Patel
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sheng F Cai
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Center for Epigenetic Research, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Linde A. Miles
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert L. Bowman
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark B. Geyer
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew Dunbar
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zachary D. Epstein-Peterson
- Weill Cornell Medical College, New York, NY
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erin McGovern
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Schulman
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacob L Glass
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Justin Taylor
- Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL
| | - Aaron D Viny
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eytan M. Stein
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Bartlomiej Getta
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Maria E. Arcila
- Molecular Diagnostics Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Qi Gao
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Juliet Barker
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Brian C. Shaffer
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Esperanza B. Papadopoulos
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Boglarka Gyurkocza
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Omar Abdel-Wahab
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ross L. Levine
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio A. Giralt
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Yanming Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wenbin Xiao
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nidhi Pai
- Georgia Institute of Technology, Atlanta, GA
| | - Elli Papaemmanuil
- Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Martin S. Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Mikhail Roshal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aaron D Goldberg
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| |
Collapse
|
17
|
Nath K, Tomas AA, Flynn J, Fein JA, Alperovich A, Anagnostou T, Batlevi CL, Dahi PB, Fingrut WB, Giralt SA, Lin RJ, Palomba ML, Peled JU, Salles G, Sauter CS, Scordo M, Fraint E, Feuer E, Shah N, Slingerland JB, Devlin S, Shah GL, Gupta G, Perales MA, Shouval R. Vitamin D Insufficiency and Clinical Outcomes with Chimeric Antigen Receptor T-Cell Therapy in Large B-cell Lymphoma. Transplant Cell Ther 2022; 28:751.e1-751.e7. [PMID: 35944603 PMCID: PMC9637764 DOI: 10.1016/j.jtct.2022.08.001] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/16/2022] [Accepted: 08/01/2022] [Indexed: 01/29/2023]
Abstract
Vitamin D insufficiency is a potentially modifiable risk factor for poor outcomes in newly diagnosed large B-cell lymphoma (LBCL). However, the role of circulating vitamin D concentrations in relapsed/refractory LBCL treated with CD19-directed chimeric antigen receptor T-cell therapy (CAR-T) is currently unknown. This was a single-center, observational study that evaluated the association of pre-CAR-T 25-hydroxyvitamin D (25-OHD) status with 100-day complete response, progression-free survival, overall survival, and CAR-T-related toxicity in 111 adult relapsed/refractory LBCL patients. Vitamin D insufficiency was defined as ≤30 ng/mL in accordance with the Endocrine Society guidelines. The median pre-CAR-T 25-hydroxyvitamin D concentration was 24 ng/mL (interquarile range = 18-34). Vitamin D-insufficient patients (≤30 ng/mL; n = 73 [66%]) were significantly younger than their vitamin D-replete (>30 ng/mL; n = 38 [34%]) counterparts (P= .039). The vitamin D-insufficient cohort was enriched for de novo LBCL as the histological subtype (P= .026) and had a higher proportion of tisagenlecleucel as the CAR-T product (P= .049). There were no other significant differences in the baseline characteristics between the two groups. In vitamin D-insufficient compared to -replete patients, 100-day complete response was 55% versus 76% (P= .029), and 2-year overall survival was 41% versus 71% (P= .061), respectively. In multivariate analysis, vitamin D insufficiency remained significantly associated with 100-day complete response (odds ratio 2.58 [1.05-6.83]; P= .045) and overall survival (hazard ratio 2.24 [1.08-4.66], P= .030). In recipients of tisagenlecleucel, vitamin D insufficiency was associated with significantly lower cell viability of the infused CAR-T product (P= .015). Finally, pretreatment vitamin D insufficiency did not predict for subsequent CAR-T-related toxicity. This is the first report to demonstrate that vitamin D insufficiency is associated with inferior clinical outcomes in CAR-T recipients. Further study into the mechanistic insights of this finding, and the potential role of vitamin D supplementation to optimize CAR-T are warranted.
Collapse
Affiliation(s)
- Karthik Nath
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ana Alarcon Tomas
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; PhD Program in Signals Integration and Modulation in Biomedicine, Cell therapy and Translational Medicine, University of Murcia, Murcia, Spain
| | - Jessica Flynn
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joshua A Fein
- University of Connecticut Medical Center, Farmington, Connecticut
| | - Anna Alperovich
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Theodora Anagnostou
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Connie Lee Batlevi
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Parastoo B Dahi
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Warren B Fingrut
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio A Giralt
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Richard J Lin
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - M Lia Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Jonathan U Peled
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Gilles Salles
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Craig S Sauter
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Michael Scordo
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Ellen Fraint
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies Program, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, Bronx, New York
| | - Elise Feuer
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nishi Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John B Slingerland
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gunjan L Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Gaurav Gupta
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Roni Shouval
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| |
Collapse
|
18
|
Mailankody S, Salcedo M, Tavitian E, Burge M, Korde N, Hassoun H, Lesokhin A, Lahoud O, Smith E, Hultcrantz M, Tan C, Shah U, Devlin S, Landgren O. Ixazomib and dexamethasone in high risk smoldering multiple myeloma: a clinical and correlative pilot study. Leuk Lymphoma 2022; 63:2760-2761. [PMID: 35838493 DOI: 10.1080/10428194.2022.2095626] [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: 04/08/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Meghan Salcedo
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Miranda Burge
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Alexander Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Oscar Lahoud
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- BMT service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Smith
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Myeloma Program and Experimental Therapeutics Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| |
Collapse
|
19
|
Devlin S, Iasonos A. Statistics in Oncology. J Clin Oncol 2022; 40:3471-3473. [PMID: 36095293 DOI: 10.1200/jco.22.01457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sean Devlin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | |
Collapse
|
20
|
Lahoud OB, Landau H, Nguyen J, Devlin S, Lendvai N, Weltz J, Ayorinde T, Chung DJ, Lesokhin AM, Kewalramani T, Korde N, Mailankody S, Landgren CO, Giralt S, Comenzo RL, Hassoun H. Continuous induction with lenalidomide/dexamethasone versus autologous stem cell transplantation in newly diagnosed multiple myeloma: a case for response-adapted approach. Leuk Lymphoma 2022; 63:2126-2135. [PMID: 35648041 PMCID: PMC9703606 DOI: 10.1080/10428194.2022.2062347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
Although upfront autologous stem cell transplantation (ASCT) generally improves progression-free survival (PFS) in newly diagnosed multiple myeloma (NDMM), the overall survival (OS) benefit and optimal timing of ASCT are not well established. Patients with early response may be able to safely continue induction and avoid ASCT without compromised outcomes. We report an extended follow-up analysis of a phase 2 trial that randomized transplant-eligible patients with NDMM who responded to induction (50/65 patients) to continued induction or ASCT; median follow-up was 8.0 years. Patients had similar 8-year PFS (55% vs. 43%), 8-year OS (83% vs. 72%), and rates of at least very good partial response (72% vs. 84%) whether continuing induction of lenalidomide and dexamethasone (Ld arm) or receiving ASCT (Ld + ASCT arm) (p = 0.5). Notably, over 50% of patients receiving continuous Ld had PFS of 5-10 years. These results suggest the need for prospective trials incorporating response-adapted therapeutic approaches to NDMM.STATEMENT OF PRIOR PRESENTATIONPresented in abstract form (interim analysis) at the 56th annual meeting of the American Society of Hematology (San Francisco, CA, 6 December 2014) and at the 57th annual meeting of the American Society of Hematology (Orlando, FL, 3 December 2015).
Collapse
Affiliation(s)
- Oscar B. Lahoud
- Adult Bone Marrow Transplant Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather Landau
- Adult Bone Marrow Transplant Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Nguyen
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Devlin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nikoletta Lendvai
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Weltz
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timininu Ayorinde
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J. Chung
- Adult Bone Marrow Transplant Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander M. Lesokhin
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tarun Kewalramani
- Department of Hematology/Oncology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Neha Korde
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C. Ola Landgren
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond L. Comenzo
- Hematology/Oncology Service, Department of Medicine, Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
| | - Hani Hassoun
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
21
|
Lin A, Brown S, Maloy M, Ruiz JD, Devlin S, DeRespiris L, Proli A, Jakubowski AA, Papadopoulos EB, Sauter CS, Tamari R, Castro-Malaspina H, Shaffer B, Barker J, Perales MA, Giralt SA, Gyurkocza B. Impact of omitting post-transplant minidose-methotrexate doses in allogeneic hematopoietic cell transplantation. Leuk Lymphoma 2022; 63:1686-1693. [PMID: 35142567 PMCID: PMC9983694 DOI: 10.1080/10428194.2022.2032036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given prophylactic methotrexate (MTX) is often held in the setting of toxicity we investigated the impact of omitting minidose-MTX dose(s). Outcomes were compared between patients who had 1-3 doses omitted and those who received all four planned doses of minidose-MTX. Of 370 consecutive patients, 50 had MTX dose(s) omitted. When MTX was omitted, initial management was mycophenolate mofetil (MMF; 36/50 patients) with or without corticosteroids (14/50 patients). Rates of grade 3-4 acute GVHD were similar between groups. Omission of minidose-MTX resulted in an increased risk of chronic GVHD (cGVHD; HR 2.27; p = .024) and decreased overall survival (HR 1.61; p = .024). However, other transplant-related outcomes were comparable. In summary, omission of minidose-MTX doses was not associated with an increased risk of acute GVHD when an alternative was added (e.g. MMF ± corticosteroids). This did not abrogate the increased risk of cGVHD or decreased overall survival.
Collapse
Affiliation(s)
- A Lin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Maloy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - JD Ruiz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - L DeRespiris
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Proli
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - AA Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - EB Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - CS Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - R Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - H Castro-Malaspina
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - B Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - J Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - MA Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - SA Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - B Gyurkocza
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| |
Collapse
|
22
|
Lin R, Ritter E, Flynn J, Ho C, Ruiz J, Jakubowski A, Papadopoulos E, Shaffer B, Castro-Malaspina H, Cho C, Ponce D, Barker J, Tamari R, Sauter C, Gyurkocza B, van den Brink M, Young J, Perales M, Devlin S, Wong P, Giralt S. Aging-related, Senescence-associated Secretory Phenotype and Allogeneic Hematopoietic Cell Transplantation Outcomes in Older Adults. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
23
|
Alarcon Tomas A, Whiting K, Maloy M, Ruiz JD, Devlin S, Sanchez-Escamilla M, Yañez L, Castillo N, Pennisi M, Cho C, Shaffer B, Castro-Malaspina H, Klimek V, Giralt SA, Tamari R, Perales MA. The post-transplant scoring system (PTSS) is associated with outcomes in patients with MDS after CD34+selected allogeneic stem cell transplant. Bone Marrow Transplant 2021; 56:2749-2754. [PMID: 34253878 PMCID: PMC8273566 DOI: 10.1038/s41409-021-01392-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022]
Abstract
The post-transplant scoring system (PTSS), developed by the Francophone Society of Bone Marrow Transplantation and Cellular Therapy, is based on three independent post-transplant risk factors: grade of acute graft-versus-host disease, lack of platelet recovery before day 100, and relapse before day 100; discriminating low- (0), intermediate- (1–3), and high-risk (4–8) patients. We investigated the prognostic value of the PTSS in a cohort of patients with MDS who underwent myeloablative CD34-selected TCD transplants. From 2008 to 2018, 109 patients underwent a first TCD-HCT for MDS at our center. We used Cox proportional hazards models and different landmark analyses to evaluate the association of categorized PTSS score risk groups with overall survival (OS). Patients with an intermediate/ high risk PTSS score had decreased OS at day 180 (univariate HR 3.25 [95% CI 1.60, 6.60], p = 0.001) and at day 365 (univariate HR 5.42 [95% CI 2.21, 13.3], p < 0.001) compared to low risk PTSS scores. This association remained significant after adjusting for HCT-CI. PTSS score calculated at day 100 was not associated with OS, even after adjusting for HCT-CI subgroups. In summary, the PTSS predicted survival at day 180 and day 365 in recipients of T-cell-depleted allografts for myelodysplastic syndrome.
Collapse
Affiliation(s)
- Ana Alarcon Tomas
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karissa Whiting
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Molly Maloy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Josel D Ruiz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miriam Sanchez-Escamilla
- Department of Hematology, University Hospital Marqués de Valdecilla, Santander, Spain.,Department of Hematological Malignancies and Stem Cell Transplantation, Research Institute of Marques de Valdecilla (IDIVAL), Santander, Spain
| | - Lucrecia Yañez
- Department of Hematology, University Hospital Marqués de Valdecilla, Santander, Spain.,Department of Hematological Malignancies and Stem Cell Transplantation, Research Institute of Marques de Valdecilla (IDIVAL), Santander, Spain
| | - Nerea Castillo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martina Pennisi
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Christina Cho
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Brian Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Hugo Castro-Malaspina
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Virginia Klimek
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.,Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| |
Collapse
|
24
|
Diamond B, Korde N, Lesokhin AM, Smith EL, Shah U, Mailankody S, Hultcrantz M, Hassoun H, Lu SX, Tan C, Rustad EH, Maura F, Maclachlan K, Peterson T, Derkach A, Devlin S, Landau HJ, Scordo M, Chung DJ, Shah GL, Lahoud O, Thoren K, Murata K, Ramanathan L, Arcila ME, Ho C, Roshal M, Dogan A, Giralt SA, Landgren O. Dynamics of minimal residual disease in patients with multiple myeloma on continuous lenalidomide maintenance: a single-arm, single-centre, phase 2 trial. Lancet Haematol 2021; 8:e422-e432. [PMID: 34048681 DOI: 10.1016/s2352-3026(21)00130-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/22/2022]
Abstract
Background Lenalidomide maintenance improves progression-free survival for patients with multiple myeloma, although its optimal duration is unknown. Clearance of minimal residual disease (MRD) in the bone marrow results in superior outcomes, although its attainment or sustainment does not alter clinical decision-making. Studies that have evaluated MRD serially are limited in length. We therefore aimed to evaluate longitudinal changes in MRD-status (dynamics) and their association with progression-free survival in patients with multiple myeloma. METHODS In this single-centre, single-arm, phase 2 study, we enrolled patients aged 18 years and older from the Memorial Sloan Kettering Cancer Center (New York, NY, USA) who had newly diagnosed multiple myeloma following unrestricted frontline therapy and an Eastern Cooperative Oncology Group Performance Status of 2 or lower, including patients who started maintenance before study enrolment. All participants received lenalidomide maintenance at 10 mg for 21 days of 28-day cycles until progression or unacceptable toxic effects for up to 5 years on protocol. The primary endpoint was progression-free survival at 60 months per protocol and key secondary endpoints were MRD rates after completion of the 12th, 24th, and 36th cycle of maintenance and the association between progression-free survival and annual measurement of MRD status. MRD was assessed from first-pull bone marrow aspirates at baseline and annually by flow cytometry per International Myeloma Working Group criteria, (limit of detection of at least 1 × 10-5) up to a maximum of 5 years. Patients who completed at least four cycles of treatment were included in the analysis of the primary endpoint, and patients who had completed at least one dose of treatment on protocol were assessable for secondary endpoints. The study was registered at ClinicalTrials.gov, NCT02538198, and is now closed to accrual. FINDINGS Between Sept 8, 2015, and Jan 25, 2019, 108 patients (100 evaluable for the primary endpoint) were enrolled. Median follow-up was 40·7 months (95% CI 38·7-45·0). At 60 months, progression-free survival was 64% (95% CI 52-79). Median progression-free survival was unreached (95% CI unreached-unreached). MRD dynamics were assessed using 340 MRD assessments done over 5 years for 103 evaluable patients. Patients who sustained MRD negativity for 2 years (n=34) had no recorded disease progression at median 19·8 months (95% CI 15·8-22·3) past the 2-year maintenance landmark. By contrast, patients who lost their MRD-negative responses (n=10) were more likely to progress than those with sustained MRD negativity (HR infinite; p<0·0001) and those with persistent MRD positivity (HR 5·88, 95% CI 1·18-33·33; p=0·015) at the 2-year landmark. Haematological and non-haematological serious adverse events occurred in 19 patients (18%). The most common adverse events of grade 3 or worse were decreased lymphocyte count in 48 (44%) patients and decreased neutrophil count in 47 (44%) patients. One death occurred on study due to sepsis and heart failure and was considered unrelated to the study drug. INTERPRETATION Serial measurements of MRD allow for dynamic assessment of risk for disease progression. Early intervention should be investigated for patients with loss of MRD negativity. Sustained MRD positivity is not categorically an unfavourable outcome and might portend prolonged stability of low-level disease. FUNDING Memorial Sloan Kettering and Celgene.
Collapse
Affiliation(s)
- Benjamin Diamond
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander M Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric L Smith
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sydney X Lu
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Even H Rustad
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francesco Maura
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tim Peterson
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather J Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oscar Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katie Thoren
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kazunori Murata
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lakshmi Ramanathan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caleb Ho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mikhail Roshal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| |
Collapse
|
25
|
Rampal RK, Pinzon-Ortiz M, Somasundara AVH, Durham B, Koche R, Spitzer B, Mowla S, Krishnan A, Li B, An W, Derkach A, Devlin S, Rong X, Longmire T, Eisman SE, Cordner K, Whitfield JT, Vanasse G, Cao ZA, Levine RL. Therapeutic Efficacy of Combined JAK1/2, Pan-PIM, and CDK4/6 Inhibition in Myeloproliferative Neoplasms. Clin Cancer Res 2021; 27:3456-3468. [PMID: 33782031 DOI: 10.1158/1078-0432.ccr-20-4898] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/01/2021] [Accepted: 03/26/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The JAK1/2 inhibitor ruxolitinib has demonstrated significant benefits for patients with myeloproliferative neoplasms (MPN). However, patients often lose response to ruxolitinib or suffer disease progression despite therapy with ruxolitinib. These observations have prompted efforts to devise treatment strategies to improve therapeutic efficacy in combination with ruxolitinib therapy. Activation of JAK-STAT signaling results in dysregulation of key downstream pathways, notably increased expression of cell-cycle mediators including CDC25A and the PIM kinases. EXPERIMENTAL DESIGN Given the involvement of cell-cycle mediators in MPNs, we sought to examine the efficacy of therapy combining ruxolitinib with a CDK4/6 inhibitor (LEE011) and a PIM kinase inhibitor (PIM447). We utilized JAK2-mutant cell lines, murine models, and primary MPN patient samples for these studies. RESULTS Exposure of JAK2-mutant cell lines to the triple combination of ruxolitinib, LEE011, and PIM447 resulted in expected on-target pharmacodynamic effects, as well as increased apoptosis and a decrease in the proportion of cells in S-phase, compared with ruxolitinib. As compared with ruxolitinib monotherapy, combination therapy led to reductions in spleen and liver size, reduction of bone marrow reticulin fibrosis, improved overall survival, and elimination of disease-initiating capacity of treated bone marrow, in murine models of MPN. Finally, the triple combination reduced colony formation capacity of primary MPN patient samples to a greater extent than ruxolitinib. CONCLUSIONS The triple combination of ruxolitinib, LEE011, and PIM447 represents a promising therapeutic strategy with the potential to increase therapeutic responses in patients with MPN.
Collapse
Affiliation(s)
- Raajit K Rampal
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.,Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Amritha Varshini Hanasoge Somasundara
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Benjamin Durham
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Richard Koche
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Barbara Spitzer
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Shoron Mowla
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Aishwarya Krishnan
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Bing Li
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Wenbin An
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xianhui Rong
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Tyler Longmire
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Shira Esther Eisman
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Keith Cordner
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Justin T Whitfield
- Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Gary Vanasse
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Zhu A Cao
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts.
| | - Ross L Levine
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York. .,Center for Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| |
Collapse
|
26
|
Novak KL, Ma C, Kheirkhahrahimabadi H, heatherington J, Ingram R, Martin M, Panaccione R, Kaplan GG, Devlin S, Seow C, Chan M, Lu C. A173 INNOVATIVE CARE FOR INFLAMMATORY BOWEL DISEASE PATIENTS DURING THE COVID-19 PANDEMIC: USE OF BEDSIDE INTESTINAL ULTRASOUND TO OPTIMIZE MANAGEMENT. J Can Assoc Gastroenterol 2021. [PMCID: PMC7958805 DOI: 10.1093/jcag/gwab002.171] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The COVID-19 pandemic has led to significant alterations in the ability to deliver outpatient care to patients with inflammatory bowel disease (IBD) including endoscopic evaluation. This has highlighted the need for alternative, accurate, non-invasive strategies to safely assess disease activity. Aims The aim of this study is to describe the impact of point of care intestinal ultrasound (IUS) in a university-based tertiary care IBD urgent access clinic. Methods We prospectively evaluated a comprehensive care pathway which incorporated outpatient sigmoidoscopy and intestinal ultrasound with the purpose of directing further ambulatory clinical care and avoiding hospitalization or hospital-based investigations including endoscopy during the COVID pandemic for patients with established IBD with symptoms suggestive of a disease flare, or those at high risk of a new diagnosis of IBD. Non-invasive markers C Reactive Protein (CRP) and fecal calprotectin (fCal) were collected where available. Patients were pre-screened for influenza-like illness, as COVID-19 testing was not available for this population during the study period. Substantial management changes were defined as addition of any medications, biologic switch/ optimization, and or referral for surgical consultation. Results Between March 15th and June 30th 2020, a total of 72 patients were seen in the urgent access clinic. All patients were seen within 7 days of referral. The majority were female 57% (41/72) and/ or had Crohn’s disease 65.5% (47/72) (Table 1). Of these, 84.7% (61/72) underwent a substantial management change based on features of active inflammation detected by either IUS alone (53% 38/72) sigmoidoscopy alone (12.5% 9/72) or combination IUS with in-clinic sigmoidoscopy (32% 23/72) in addition to CRP and fCal. Three new diagnoses of IBD were made: one colonic Crohn’s and 2 with ulcerative colitis. One pregnant patient avoided all acute care utilization. Five patients were referred to colorectal surgery for urgent resection including two patients admitted directly for emergent operations. No patients required visits to the emergency department. Furthermore, there have been no unscheduled hospitalizations occurred in this cohort since inception March 23, 2020 til November 15th 2020. Conclusions The implementation of IUS in a centralized, urgent access clinic pathway resulted in efficient and meaningful changes in IBD management while sparing the need for acute care services including ER visits, need for in-hospital endoscopy, and hospitalization. The pandemic highlights the utility of this patient-center tool and supports expansion of wider IUS adoption. Funding Agencies None
Collapse
Affiliation(s)
- K L Novak
- Gastroenterology, University of Calgary, Calgary AB, AB, Canada
| | - C Ma
- University of Calgary, Calgary, AB, Canada
| | | | | | - R Ingram
- Gastroenterology, University of Calgary, Calgary AB, AB, Canada
| | - M Martin
- Alberta Health Services, Calgary, AB, Canada
| | | | - G G Kaplan
- Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - S Devlin
- University of Calgary, Calgary, AB, Canada
| | - C Seow
- Medicine, University of Calgary, Calgary, AB, Canada
| | - M Chan
- Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - C Lu
- Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| |
Collapse
|
27
|
Jee J, Stonestrom AJ, Devlin S, Nguyentran T, Wills B, Narendra V, Foote MB, Lumish M, Vardhana SA, Pastores SM, Korde N, Patel D, Horwitz S, Scordo M, Daniyan AF. Oncologic immunomodulatory agents in patients with cancer and COVID-19. Sci Rep 2021; 11:4814. [PMID: 33649382 PMCID: PMC7921444 DOI: 10.1038/s41598-021-84137-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022] Open
Abstract
Corticosteroids, anti-CD20 agents, immunotherapies, and cytotoxic chemotherapy are commonly used in the treatment of patients with cancer. It is unclear how these agents affect patients with cancer who are infected with SARS-CoV-2. We retrospectively investigated associations between SARS-CoV-2-associated respiratory failure or death with receipt of the aforementioned medications and with pre-COVID-19 neutropenia. The study included all cancer patients diagnosed with SARS-CoV-2 at Memorial Sloan Kettering Cancer Center until June 2, 2020 (N = 820). We controlled for cancer-related characteristics known to predispose to worse COVID-19 as well as level of respiratory support during corticosteroid administration. Corticosteroid administration was associated with worse outcomes prior to use of supplemental oxygen; no statistically significant difference was observed in sicker cohorts. In patients with metastatic thoracic cancer, 9 of 25 (36%) and 10 of 31 (32%) had respiratory failure or death among those who did and did not receive immunotherapy, respectively. Seven of 23 (30%) and 52 of 187 (28%) patients with hematologic cancer had respiratory failure or death among those who did and did not receive anti-CD20 therapy, respectively. Chemotherapy itself was not associated with worse outcomes, but pre-COVID-19 neutropenia was associated with worse COVID-19 course. Relative prevalence of chemotherapy-associated neutropenia in previous studies may account for different conclusions regarding the risks of chemotherapy in patients with COVID-19. In the absence of prospective studies and evidence-based guidelines, our data may aid providers looking to assess the risks and benefits of these agents in caring for cancer patients in the COVID-19 era.
Collapse
Affiliation(s)
- Justin Jee
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Aaron J Stonestrom
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Teresa Nguyentran
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Beatriz Wills
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Varun Narendra
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Michael B Foote
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Melissa Lumish
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Santosha A Vardhana
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Stephen M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neha Korde
- 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
| | - Dhwani Patel
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Steven Horwitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Michael Scordo
- 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.
| | - Anthony F Daniyan
- 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.
| |
Collapse
|
28
|
Epstein-Peterson ZD, Chokshi I, Barrow B, Lobaugh S, Devlin S, Fenelus M, Soff G. Laboratory evaluation of folate deficiency among inpatients with cancer. Int J Lab Hematol 2021; 43:O164-O167. [PMID: 33580731 DOI: 10.1111/ijlh.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Zachary D Epstein-Peterson
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ishita Chokshi
- Department of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brooke Barrow
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Stephanie Lobaugh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maly Fenelus
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gerald Soff
- Hematology Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
29
|
Garcia-Recio M, Wudhikarn K, Pennisi M, Alonso-Trillo R, Flynn J, Shouval R, Afuye AO, Silverberg ML, Batlevi CW, Dahi P, Devlin S, Giralt SA, Halton E, Ruiz J, Maloy M, Mead E, Palomba ML, Santomasso B, Sauter CS, Scordo M, Shah GL, Perales MA. The International Prognostic Index Is Associated with Outcomes in Diffuse Large B Cell Lymphoma after Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2020; 27:233-240. [PMID: 33781518 DOI: 10.1016/j.jtct.2020.10.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/20/2020] [Accepted: 10/21/2020] [Indexed: 01/07/2023]
Abstract
CD19-targeted chimeric antigen receptor (CAR) T cells have shown excellent activity against relapsed and refractory (R/R) diffuse large B cell lymphoma (DLBCL). CAR T cell therapy is associated with early toxicities, including cytokine release syndrome and neurotoxicity. The incidence and severity of these toxicities has been associated in part with baseline disease and patient characteristics, which also may impact overall survival (OS) and progression-free survival (PFS). However, there are limited data on patient selection and how to better predict toxicities or outcomes. Indexes used in patients with DLBCL, such as the International Prognostic Index (IPI and age-adjusted IPI [aaIPI]) and in transplantation recipients, such as the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), have not been evaluated in this setting. Here we evaluated 4 indices- IPI, aaIPI, HCT-CI, and the Charlson Comorbidity Index (CCI)-and their associations with early CAR T cell related-toxicities and outcomes. We demonstrated an association between high-risk IPI or aaIPI and inferior PFS in patients with R/R DLBCL treated with CAR T cell therapy. We also found an association between aaIPI and IPI with OS and neurotoxicity, respectively. CCI was not associated with toxicities or outcomes, and owing to the small sample size, we could not draw a conclusion regarding associations with the HCT-CI. Both the IPI and aaIPI are widely used tools that can now provide better information to guide selection of patients who would best benefit from CD19 CAR T cell therapy.
Collapse
Affiliation(s)
- Marta Garcia-Recio
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kitsada Wudhikarn
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Division of Hematology and Research Unit in Translational Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Martina Pennisi
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Oncology and Onco-Hematology Department, University of Milan, Milan, Italy; Hematology Service, Oncology and Hematology Department, Instituto Nazionale dei Tumori, Milan, Italy
| | - Rosalia Alonso-Trillo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Hematology Service, Hospital Puerta de Hierro, Majadahonda, Spain
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roni Shouval
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aishat O Afuye
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mari Lynne Silverberg
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Connie W Batlevi
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College; New York, New York
| | - Parastoo Dahi
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College; New York, New York
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College; New York, New York
| | - Elizabeth Halton
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Josel Ruiz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Molly Maloy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena Mead
- Neurology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College; New York, New York
| | - M Lia Palomba
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College; New York, New York
| | - Bianca Santomasso
- Neurology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College; New York, New York
| | - Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College; New York, New York
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College; New York, New York
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College; New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Intensive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College; New York, New York.
| |
Collapse
|
30
|
Sermer D, Batlevi C, Palomba ML, Shah G, Lin RJ, Perales MA, Scordo M, Dahi P, Pennisi M, Afuye A, Silverberg ML, Ho C, Flynn J, Devlin S, Caron P, Hamilton A, Hamlin P, Horwitz S, Joffe E, Kumar A, Matasar M, Noy A, Owens C, Moskowitz A, Straus D, von Keudell G, Rodriguez-Rivera I, Falchi L, Zelenetz A, Yahalom J, Younes A, Sauter C. Outcomes in patients with DLBCL treated with commercial CAR T cells compared with alternate therapies. Blood Adv 2020; 4:4669-4678. [PMID: 33002134 PMCID: PMC7556134 DOI: 10.1182/bloodadvances.2020002118] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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: 04/24/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
The prognosis of patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) is poor. Chimeric antigen receptor (CAR) T-cell therapy has been approved for R/R DLBCL after 2 prior lines of therapy based on data from single-arm phase 2 trials, with complete responses (CRs) in 40% to 60% of patients. However, a direct comparison with other treatments is not available and, moreover, its true efficacy in real-world patients is unknown. In this single center, retrospective, observational study of 215 patients, we compared outcomes in patients treated with CAR T-cell therapy (n = 69) with a historical population treated with alternate therapies (n = 146). Patients treated with CAR T cell vs alternate therapies demonstrated a CR rate of 52% vs 22% (P < .001), median progression-free survival (PFS) of 5.2 vs 2.3 months (P = .01), and median overall survival (OS) of 19.3 vs 6.5 months (P = .006), and this advantage appeared to persist irrespective of the number of lines of prior therapy. After adjusting for unfavorable pretreatment disease characteristics, superior overall response rate in the CAR T cohort remained significant; however, differences in PFS and OS between cohorts did not. In addition, patients who responded to alternate therapies demonstrated prolonged remissions comparable to those who responded to CAR T therapy. We contend that in select clinical scenarios alternate therapies may be as efficacious as CAR T therapy; thus, additional study is warranted, ideally with randomized prospective trials.
Collapse
Affiliation(s)
- David Sermer
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connie Batlevi
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - M Lia Palomba
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Gunjan Shah
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
- Adult Bone Marrow Transplant Service, Department of Medicine
| | - Richard J Lin
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
- Adult Bone Marrow Transplant Service, Department of Medicine
| | - Miguel-Angel Perales
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
- Adult Bone Marrow Transplant Service, Department of Medicine
| | - Michael Scordo
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
- Adult Bone Marrow Transplant Service, Department of Medicine
| | - Parastoo Dahi
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
- Adult Bone Marrow Transplant Service, Department of Medicine
| | - Martina Pennisi
- Adult Bone Marrow Transplant Service, Department of Medicine
| | - Aishat Afuye
- Adult Bone Marrow Transplant Service, Department of Medicine
| | | | | | | | - Sean Devlin
- Department of Epidemiology and Biostatistics, and
| | - Philip Caron
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Audrey Hamilton
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Paul Hamlin
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Steven Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Erel Joffe
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Anita Kumar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Matthew Matasar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Ariela Noy
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Colette Owens
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Alison Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - David Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Gottfried von Keudell
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Ildefonso Rodriguez-Rivera
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Lorenzo Falchi
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Andrew Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anas Younes
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Craig Sauter
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
- Adult Bone Marrow Transplant Service, Department of Medicine
| |
Collapse
|
31
|
Hassoun H, Bayer R, Devlin S, Gentile T, Becker M, O'Dweyer K, Lesser M, Landau H, Chung D, Giralt S. A phase II clinical trial of lenalidomide intensification in patients with serologic/asymptomatic progression of multiple myeloma while on lenalidomide maintenance: a tri-state transplant consortium study. Leuk Lymphoma 2020; 61:488-490. [PMID: 31957517 DOI: 10.1080/10428194.2019.1672058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Hani Hassoun
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ruthee Bayer
- Northwell Health Cancer Institute, Long Island Jewish Medical Center, North Shore University Hospital, the Monter Cancer Center, Lake Success, NY, USA
| | - Sean Devlin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Theresa Gentile
- Upstate University Hospital, Professor of Medicine, Syracuse, NY, USA
| | - Michael Becker
- Adult Bone Marrow Transplant Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristen O'Dweyer
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Martin Lesser
- University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Heather Landau
- Biostatistics Unit, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - David Chung
- Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Sergio Giralt
- Adult BMT Service, Melvin Berlin Family Chair in Myeloma Research, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
32
|
Maples KT, Maloy M, Devlin S, Lin A, DeRespiris L, Griffin M, Lau C, Proli AJ, Papanicolaou GA, Seo SK, Barker JN, Perales MA, Giralt SA, Bhatt V. Lack of a significant pharmacokinetic interaction between letermovir and calcineurin inhibitors in allogeneic HCT recipients. Bone Marrow Transplant 2020; 55:1687-1689. [PMID: 31937928 DOI: 10.1038/s41409-020-0785-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Kathryn T Maples
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Molly Maloy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Devlin
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Lin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren DeRespiris
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meagan Griffin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carmen Lau
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony J Proli
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Genovefa A Papanicolaou
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Susan K Seo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Juliet N Barker
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Miguel-Angel Perales
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sergio A Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Valkal Bhatt
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
33
|
Landgren O, Hofmann JN, McShane CM, Santo L, Hultcrantz M, Korde N, Mailankody S, Kazandjian D, Murata K, Thoren K, Ramanathan L, Dogan A, Rustad E, Lu SX, Akhlaghi T, Kristinsson SY, Björkholm M, Devlin S, Purdue MP, Pfeiffer RM, Turesson I. Association of Immune Marker Changes With Progression of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma. JAMA Oncol 2019; 5:1293-1301. [PMID: 31318385 PMCID: PMC6646992 DOI: 10.1001/jamaoncol.2019.1568] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/15/2019] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Multiple myeloma is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). Risk models that estimate the risk of progression from MGUS to multiple myeloma use data from a single time point, usually the initial workup. OBJECTIVE To longitudinally investigate the alterations of serum immune markers with stable vs progressive MGUS. DESIGN, SETTING, AND PARTICIPANTS This prospective cross-sectional cohort study included 77 469 adult participants aged 55 to 74 years in the screening arm of the National Cancer Institute Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial who had a diagnosis of progressing MGUS (n = 187) or stable MGUS (n = 498), including light-chain subtype, from November 1993, through December 2011. For each participant, all available serially stored prediagnostic serum samples (N = 3266) were obtained. Data analysis was performed from April 2018, to December 2018. MAIN OUTCOMES AND MEASURES Serum protein and monoclonal immunoglobulin levels, serum free light chains, and serum light chains within each immunoglobulin class were measured. RESULTS Of 685 individuals included in the study, 461 (67.3%) were men; the mean (SD) age was 69.1 (5.6) years. In cross-sectional modeling, risk factors associated with progressive MGUS were IgA isotype (adjusted odds ratio [OR], 1.80; 95% CI, 1.03-3.13; P = .04), 15 g/L or more monoclonal spike (adjusted OR, 23.5; 95% CI, 8.9-61.9; P < .001), skewed (<0.1 or >10) serum free light chains ratio (adjusted OR, 46.4; 95% CI, 18.4-117.0; P < .001), and severe immunoparesis (≥2 suppressed uninvolved immunoglobulins) (adjusted OR, 19.1; 95% Cl, 7.5-48.3; P < .001). Risk factors associated with progressive light-chain MGUS were skewed serum free light chains ratio (adjusted OR, 44.0; 95% CI, 14.2-136.3; P < .001) and severe immunoparesis (adjusted OR, 48.6; 95% CI, 9.5-248.2; P < .001). In longitudinal analysis of participants with serial samples prior to progression, 23 of 43 participants (53%) had high-risk MGUS before progression; 16 of these 23 (70%) experienced conversion from low-risk or intermediate-risk MGUS within 5 years. Similar results were found for light-chain MGUS. CONCLUSIONS AND RELEVANCE The findings of evolving risk patterns support annual blood testing and risk assessment for patients with MGUS or light-chain MGUS.
Collapse
Affiliation(s)
- Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan N. Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Charlene M. McShane
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University, Belfast, Northern Ireland, United Kingdom
| | - Loredana Santo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Division of Hematology, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Kazunori Murata
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katie Thoren
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lakshmi Ramanathan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmet Dogan
- Department of Hematopathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Even Rustad
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sydney X. Lu
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Theresia Akhlaghi
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sigurdur Y. Kristinsson
- Division of Hematology, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Magnus Björkholm
- Division of Hematology, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark P. Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Ingemar Turesson
- Myeloma Section, Department of Medicine, University Hospital of Malmo, Malmo, Sweden
| |
Collapse
|
34
|
Landau H, Lahoud O, Devlin S, Lendvai N, Chung DJ, Dogan A, Landgren CO, Giralt S, Hassoun H. Pilot Study of Bortezomib and Dexamethasone Pre- and Post-Risk-Adapted Autologous Stem Cell Transplantation in AL Amyloidosis. Biol Blood Marrow Transplant 2019; 26:204-208. [PMID: 31446197 DOI: 10.1016/j.bbmt.2019.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022]
Abstract
Treatment for AL amyloidosis aims to eradicate clonal plasma cells, thereby disrupting the amyloid deposition causing organ damage. Risk-adapted high-dose melphalan plus autologous stem cell transplantation (RA-ASCT) is an effective therapy. We conducted a prospective pilot analysis of a comprehensive approach using bortezomib and dexamethasone (BD) before and after RA-ASCT in 19 patients. BD induction (up to 3 cycles of bortezomib 1.3 mg/m2 i.v. and dexamethasone 40 mg orally [p.o.] or i.v. on days 1, 4, 8, and 11) was followed by RA-ASCT and then BD consolidation (6 cycles of bortezomib 1.3 mg/m2i.v. and dexamethasone 20 mg p.o. or i.v. weekly for 4 weeks, every 12 weeks). The overall hematologic response rate (partial response or better) was 95%, including 37% minimal residual disease negative [MRD(-)] complete response (CR) by flow cytometry (sensitivity up to 1/106 cells). At 2 years, progression-free survival (PFS) and overall survival were 68% (95% confidence interval [CI], 50% to 93%) and 84% (95% CI, 69% to 99%), respectively, with median duration of follow-up in survivors of 61 months (range, 42 to 84 months). In a landmark analysis, patients achieving MRD(-) CR had superior PFS (P= .008). This approach is safe and yields deep and durable remissions promoting organ recovery. Each treatment phase deepened the response. Future aims include improving the efficacy and toxicity of each phase.
Collapse
Affiliation(s)
- Heather Landau
- Adult Bone Marrow Transplant Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oscar Lahoud
- Adult Bone Marrow Transplant Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nikoletta Lendvai
- Myeloma Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David J Chung
- Adult Bone Marrow Transplant Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C Ola Landgren
- Myeloma Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hani Hassoun
- Myeloma Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| |
Collapse
|
35
|
Stanchina M, Pastore A, Devlin S, Famulare C, Stein E, Taylor J. CD33 splice site genotype was not associated with outcomes of patients receiving the anti-CD33 drug conjugate SGN-CD33A. J Hematol Oncol 2019; 12:85. [PMID: 31439003 PMCID: PMC6704571 DOI: 10.1186/s13045-019-0771-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022] Open
Abstract
We tested whether a single nucleotide polymorphism (SNP) that affects splicing of CD33 predicted response to treatment in adults with acute myeloid leukemia (AML) who received the novel CD33 antibody-drug conjugate SGN-CD33A. This genotype, for the CD33 splice site SNP rs12459419, was not associated with clinical response (30% CR/CRi in both groups), event-free survival, or overall survival.
Collapse
Affiliation(s)
- Michele Stanchina
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alessandro Pastore
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Devlin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher Famulare
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eytan Stein
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Justin Taylor
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| |
Collapse
|
36
|
Soff GA, Mones J, Wilkins C, Devlin S, Haegler‐Laube E, Wills J, Sarasohn DM, Juluru K, Singer M, Miao Y, Batista J, Mantha S. Rivaroxaban treatment of cancer-associated venous thromboembolism: Memorial Sloan Kettering Cancer Center institutional experience. Res Pract Thromb Haemost 2019; 3:349-356. [PMID: 31294321 PMCID: PMC6611365 DOI: 10.1002/rth2.12215] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Low-molecular-weight heparin has been the preferred treatment of cancer-associated thrombosis (CAT); however, emerging data support the use of direct oral anticoagulants (DOACs). OBJECTIVES The Memorial Sloan Kettering Cancer Center Clinical Pathway has served as the institutional guideline for the use of rivaroxaban to treat CAT since 2014. Key elements are to recommend against use of a DOAC in patients with active gastrointestinal (GI) or genitourinary tract lesions, and a prespecified dose reduction in the elderly (75+ years old). We present our institutional experience for treatment of CAT. METHODS From January 2014 through September 2016, 1072 patients began rivaroxaban treatment for CAT; 91.9% had a solid tumor, 8.1% had hematologic malignancies, and 75% of patients with solid tumors had metastatic disease. All patients with CAT treated with rivaroxaban were included in this analysis, regardless of adherence to the Clinical Pathway. RESULTS The 6-month cumulative incidence of recurrent venous thromboembolism and major bleeding were 4.2% (95% confidence interval [CI], 2.7%-5.7%) and 2.2% (95% CI, 1.1%-3.2%), respectively. The incidence of clinically relevant non-major bleeding leading to discontinuation of rivaroxaban for at least 7 days was 5.5% (95% CI, 3.7%-7.1%), and 73.3% of major bleeds occurred in the GI tract. The 6-month cumulative mortality rate was 22.2% (95% CI, 19.4%-24.9%). The elderly had similar rates of recurrent thrombosis and bleeding as those aged under 75 years. CONCLUSION Our institutional experience suggests that in appropriately selected patients, rivaroxaban may be used for treatment of CAT with promising safety and efficacy.
Collapse
Affiliation(s)
- Gerald A. Soff
- Department of Medicine/Division of Hematologic OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Jodi Mones
- Department of Medicine/Division of Hematologic OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Cy Wilkins
- Department of Medicine/Division of Hematologic OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Sean Devlin
- Department of BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Eva Haegler‐Laube
- Department of Cardiology, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Jonathan Wills
- Department of Information SystemsMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Debra M. Sarasohn
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Krishna Juluru
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Michael Singer
- Department of Information SystemsMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Yimei Miao
- Department of Medicine/Division of Hematologic OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Jeanette Batista
- Department of Medicine/Division of Hematologic OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Simon Mantha
- Department of Medicine/Division of Hematologic OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| |
Collapse
|
37
|
Panaccione N, Novak KL, Seow C, Devlin S, Lu C, Heatherington J, Kaplan GG, Panaccione R. A122 COMBINATION BIOLOGIC THERAPY IN INFLAMMATORY BOWEL DISEASE: THE CALGARY EXPERIENCE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - K L Novak
- University of Calgary, Calgary, AB, Canada
| | - C Seow
- University of Calgary, Calgary, AB, Canada
| | - S Devlin
- University of Calgary, Calgary, AB, Canada
| | - C Lu
- University of Calgary, Calgary, AB, Canada
| | | | - G G Kaplan
- University of Calgary, Calgary, AB, Canada
| | | |
Collapse
|
38
|
Rosillo C, Avila AM, Huang YT, Devlin S, Cho C, Montoro J, Maloy MA, Papanicolaou GA, Barba P, Perales MA. Sequential systematic anti-mold prophylaxis with micafungin and voriconazole results in very low incidence of invasive mold infections in patients undergoing allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2018; 20:e12897. [PMID: 29668073 DOI: 10.1111/tid.12897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/25/2018] [Accepted: 02/05/2018] [Indexed: 11/30/2022]
Abstract
Recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk for invasive mold infections (IMI). The goal of the study is to describe the incidence and outcome of IMI in patients after allo-HSCT in a large cohort of patients receiving anti-mold prophylaxis. We conducted a retrospective review of 988 consecutive adults who underwent allo-HSCT in our center from 2008 through 2014. Standard prophylaxis consisted of micafungin 150 mg IV daily from admission to day +7 ± 3 followed by voriconazole until day +75 to +100. Cases meeting criteria for proven or probable IMI according to EORTC-MSG criteria were included. Median age at HSCT was 54 years. The most common diagnoses were acute myeloid leukemia (n = 351, 36%) and lymphoid malignancies (n = 248, 25%). Matched related or unrelated donors (URD) were used in 686 (69%) patients, mismatched URD in 142 (14%) and cord blood units in 154 (16%). Twenty-one patients were diagnosed with IMI after allo-HSCT, 19 probable and 2 proven, and one patient was diagnosed postmortem. Microbiological diagnosis was established in 9 cases, 5 of them being Aspergillus. One-year cumulative incidence (CI) of IMI was 1.6% (95% CI 0.9-2.5) while 12-week overall survival after IMI was 39% (95% CI 24-65) Analyzed by disease, there was a trend for a higher 1-year CI of IMI in patients with ALL (5% [95% CI 1.6-11.4]) when compared with AML (1.4%), MDS (1.5%) and lymphoma (1.2%), P = .06. The 1-year CI of IMI after transplantation is low in patients receiving anti-mold prophylaxis with micafungin bridged to voriconazole, although these infections are associated with a higher risk of mortality.
Collapse
Affiliation(s)
- Claudia Rosillo
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Ana Maria Avila
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,La Sabana School of Medicine, Bogota, Colombia
| | - Yao-Ting Huang
- Department of Medicine, Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Devlin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Christina Cho
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Juan Montoro
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Hospital Universitario La Fe, Valencia, Spain
| | - Molly A Maloy
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Genovefa A Papanicolaou
- Department of Medicine, Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Pere Barba
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Hospital Universitario Vall d'Hebron- Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
39
|
Ma C, Fedorak R, Kaplan GG, Dieleman LA, Devlin S, Stern N, Kroeker KI, Seow C, Leung Y, Novak KL, Halloran BP, Huang V, Wong K, Ghosh S, Panaccione R. A108 USTEKINUMAB IS EFFECTIVE FOR INDUCING CLINICAL, ENDOSCOPIC, AND RADIOGRAPHIC RESPONSE IN REFRACTORY MODERATE-TO-SEVERE CROHN’S DISEASE: A MULTICENTRE COHORT STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Ma
- University of Calgary, Calgary, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - G G Kaplan
- University of Calgary, Calgary, AB, Canada
| | | | - S Devlin
- University of Calgary, Calgary, AB, Canada
| | - N Stern
- University of Alberta, Edmonton, AB, Canada
| | | | - C Seow
- University of Calgary, Calgary, AB, Canada
| | - Y Leung
- University of Calgary, Calgary, AB, Canada
| | - K L Novak
- University of Calgary, Calgary, AB, Canada
| | | | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - S Ghosh
- University of Birmingham, Birmingham, United Kingdom
| | | |
Collapse
|
40
|
Shim H, Ma C, Al-Farhan H, Aldarmaki AK, Pang J, Seow C, Fedorak R, Devlin S, Dieleman LA, Kaplan GG, Novak KL, Kroeker KI, Halloran BP, Panaccione R. A107 POSTOPERATIVE OUTCOMES AMONG USTEKINUMAB TREATED CROHN’S DISEASE PATIENTS: A MULTICENTRE CANADIAN PROVINCIAL EXPERIENCE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Shim
- Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - C Ma
- University of Calgary, Calgary, AB, Canada
| | - H Al-Farhan
- Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - A K Aldarmaki
- Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - J Pang
- University of Calgary, Calgary, AB, Canada
| | - C Seow
- Medicine, University of Calgary, Calgary, AB, Canada
| | - R Fedorak
- Los Alamos National Laboratory, Edmonton, AB, Canada
| | - S Devlin
- University of Calgary, Calgary, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - G G Kaplan
- Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - K L Novak
- Gastroenterology, University of Calgary, Calgary AB, Canada
| | - K I Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | | |
Collapse
|
41
|
Ma C, Fedorak R, Kaplan GG, Dieleman LA, Devlin S, Stern N, Kroeker KI, Seow C, Leung Y, Novak KL, Halloran BP, Huang V, Wong K, Ghosh S, Panaccione R. A106 USTEKINUMAB IS EFFECTIVE FOR MAINTAINING CLINICAL RESPONSE IN REFRACTORY MODERATE-TO-SEVERE CROHN’S DISEASE: A MULTICENTRE COHORT STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Ma
- University of Calgary, Calgary, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - G G Kaplan
- University of Calgary, Calgary, AB, Canada
| | | | - S Devlin
- University of Calgary, Calgary, AB, Canada
| | - N Stern
- University of Alberta, Edmonton, AB, Canada
| | | | - C Seow
- University of Calgary, Calgary, AB, Canada
| | - Y Leung
- University of Calgary, Calgary, AB, Canada
| | - K L Novak
- University of Calgary, Calgary, AB, Canada
| | | | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - S Ghosh
- University of Calgary, Calgary, AB, Canada
| | | |
Collapse
|
42
|
Ma C, Kotze P, Almutairdi A, Al-Darmaki A, Devlin S, Kaplan GG, Seow C, Novak KL, Lu C, Ferraz J, Stewart MJ, Buresi MC, Mathivanan M, Heatherington J, Martin M, Panaccione R. A116 LOSS OF RESPONSE TO VEDOLIZUMAB MAINTENANCE THERAPY IN CROHN`S DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Ma
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - P Kotze
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - A Almutairdi
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - A Al-Darmaki
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - S Devlin
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - G G Kaplan
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - C Seow
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - K L Novak
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - C Lu
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - J Ferraz
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - M J Stewart
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - M c Buresi
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - M Mathivanan
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - J Heatherington
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - M Martin
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - R Panaccione
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
43
|
Kotze P, Ma C, Almutairdi A, Al-Darmaki A, Devlin S, Kaplan GG, Seow C, Novak KL, Lu C, Ferraz J, Stewart MJ, Buresi MC, Mathivanan M, Heatherington J, Martin M, Panaccione R. A115 CLINICAL, RADIOGRAPHIC, AND ENDOSCOPIC REMISSION WITH VEDOLIZUMAB TREATMENT IN CROHN’S DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Kotze
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - C Ma
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - A Almutairdi
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - A Al-Darmaki
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - S Devlin
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - G G Kaplan
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - C Seow
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - K L Novak
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - C Lu
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - J Ferraz
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - M J Stewart
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - M c Buresi
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - M Mathivanan
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - J Heatherington
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - M Martin
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - R Panaccione
- Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
44
|
Getta BM, Devlin S, Park JH, Tallman MS, Berman E. Disease characteristics and clinical outcomes in patients aged less than 40 with chronic lymphocytic leukemia. Leuk Res 2018; 65:80-85. [DOI: 10.1016/j.leukres.2017.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/04/2017] [Accepted: 12/31/2017] [Indexed: 10/18/2022]
|
45
|
Davis E, Devlin S, Cooper C, Nhaissi M, Paulson J, Wells D, Scaradavou A, Giralt S, Papadopoulos E, Kernan NA, Byam C, Barker JN. Validation of an Algorithm to Predict the Likelihood of an 8/8 HLA-Matched Unrelated Donor at Search Initiation. Biol Blood Marrow Transplant 2017; 24:1057-1062. [PMID: 29287807 DOI: 10.1016/j.bbmt.2017.12.791] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 08/22/2017] [Accepted: 12/19/2017] [Indexed: 01/01/2023]
Abstract
A strategy to rapidly determine if a matched unrelated donor (URD) can be secured for allograft recipients is needed. We sought to validate the accuracy of (1) HapLogic match predictions and (2) a resultant novel Search Prognosis (SP) patient categorization that could predict 8/8 HLA-matched URD(s) likelihood at search initiation. Patient prognosis categories at search initiation were correlated with URD confirmatory typing results. HapLogic-based SP categorizations accurately predicted the likelihood of an 8/8 HLA-match in 830 patients (1530 donors tested). Sixty percent of patients had 8/8 URD(s) identified. Patient SP categories (217 very good, 104 good, 178 fair, 33 poor, 153 very poor, 145 futile) were associated with a marked progressive decrease in 8/8 URD identification and transplantation. Very good to good categories were highly predictive of identifying and receiving an 8/8 URD regardless of ancestry. Europeans in fair/poor categories were more likely to identify and receive an 8/8 URD compared with non-Europeans. In all ancestries very poor and futile categories predicted no 8/8 URDs. HapLogic permits URD search results to be predicted once patient HLA typing and ancestry is obtained, dramatically improving search efficiency. Poor, very poor, andfutile searches can be immediately recognized, thereby facilitating prompt pursuit of alternative donors.
Collapse
Affiliation(s)
- Eric Davis
- Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Candice Cooper
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Nhaissi
- Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer Paulson
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah Wells
- Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andromachi Scaradavou
- Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Esperanza Papadopoulos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Nancy A Kernan
- Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Courtney Byam
- Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| |
Collapse
|
46
|
Coombs C, Kuk D, Devlin S, Siegelbaum RH, Durack JC, Parameswaran R, Mantha S, Deng K, Soff G. Outcomes after inferior vena cava filter placement in cancer patients diagnosed with pulmonary embolism: risk for recurrent venous thromboembolism. J Thromb Thrombolysis 2017; 44:489-493. [DOI: 10.1007/s11239-017-1557-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
47
|
Koehne G, Devlin S, Chung DJ, Landau HJ, Korde N, Mailankody S, Hassoun H, Lesokhin AM, Lendvai N, Giralt S, Landgren CO. WT1 heteroclitic epitope immunization following autologous stem cell transplantation in patients with high-risk multiple myeloma (MM). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.8016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8016 Background: Host T-cells mount immune responses (IR’s) against Wilms tumor 1 (WT1) in A*0201+MM pts through formation of WT1 peptide fragment (RMFPNAPYL)/HLA-A*0201 complex. We report initial results from MM pts immunized with the WT1 heteroclitic peptide mixture galinpepimut-S (GPS) after autoSCT. Methods: 16 MM pts underwent autoSCT with melphalan conditioning followed by (f/b) lenalidomide maintenance starting 3 months (mos) post-SCT. 13/16 pts presented with high-risk (HR) cytogenetics [t(4;14), t(14;16), del17p, 1q21/25 gain and/or del13q]. GPS was administered with montanide s.c. starting 2 wks post-SCT and q.2 wks thereafter x 6 initial doses f/b boosters q.4 wks x 6 additional doses. GM-CSF was given on days -2 and 0 of each cycle. GPS consisted of 4 peptides: WT1-A1: Y*MFPNAPYL; 427-L (long): RSDELVRHHNMHQRNMTKL; 331-L: PGCNKRYFKLSHLQMHSRKHTG, and 122A1-L: SGQAY*MFPNAPYLPSCLES. 2 of the 4 peptides were mutated at a single residue (*) to induce stronger HLA-binding/reduce tolerance. WT1-specific IR’s were assessed by intracellular IFN-g analyses post-challenge with PBMC’s pulsed with a ‘total pool’ of overlapping 15mers along the entire WT1 protein; or each of the 4 WT1 peptides in GPS; or the non-mutated (native) WT1 peptides corresponding to the 2 heteroclitic sequences. Results: 16 pts; median follow-up: 18 mos (range: 5-31 mos) for survivors; median age: 61.6 y. Overall survival (OS) and progression-free survival (PFS) (95% CI) at 18 mos: 0.88 (0.73-0.99) and 0.62 (0.42-0.97) respectively. Current median PFS: 23.6 mos (15.2 - not reached). No >G2 systemic side effects were observed, however, all pts developed local nodularity at the site of injections which resolved over 2 – 6 wks. Both CD8+ and CD4+ IR’s could be detected at various levels and were induced not only against the heteroclitic peptides (within GPS), but also against the corresponding native WT1 peptide sequences as well as the ‘total pool’ of WT1-derived overlapping peptides. Conclusions: Administration of the novel WT1 heteroclitic peptide immunizer GPS post auto SCT demonstrates favorable safety profile along with encouraging mPFS of currently 23.6 mos in this high-risk MM population. Clinical trial information: NCT01827137.
Collapse
Affiliation(s)
| | - Sean Devlin
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Neha Korde
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Hani Hassoun
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Sergio Giralt
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | |
Collapse
|
48
|
Glezerman IG, Devlin S, Maloy M, Bui M, Jaimes EA, Giralt SA, Jakubowski AA. Long term renal survival in patients undergoing T-Cell depleted versus conventional hematopoietic stem cell transplants. Bone Marrow Transplant 2017; 52:733-738. [PMID: 28092350 PMCID: PMC5415423 DOI: 10.1038/bmt.2016.343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/04/2016] [Accepted: 11/14/2016] [Indexed: 12/04/2022]
Abstract
Calcineurin inhibitor-sparing T cell depleted (TCD) hematopoietic stem cell transplants HSCTs are presumed less nephrotoxic than conventional HSCTs. We evaluated incidence and risk factors for kidney failure and chronic kidney disease (CKD) in 231 TCD and 212 conventional HSCT recipients. Kidney failure required a median glomerular filtration rate (GFR) <60 mL/min/1.73 m2 for ≥ 100 days anytime after 180 days post-HSCT. Two year cumulative incidence (CI) of kidney failure was 42% in the conventional vs. 31% in the TCD group (p=0.005). TCD, age, acute kidney injury and number of toxic CNI levels all impacted on kidney failure, which was associated with increased all-cause mortality (hazard ratio 2.86 (95% CI: 1.88–4.36), p <0.001). Renal recovery occurred in 28% of kidney failure patients, while the remaining patients were defined to have chronic kidney disease (CKD). In those with baseline GFR>60 mL/min/1.73 m2 only exposure to nephrotoxic medications was associated with CKD (p=0.033). In the myeloablative conditioning subgroup only total body irradiation was associated with CKD (p=0.013). Of all patients, five (1.13%) required dialysis. These results confirm an impact of TCD on kidney failure but not CKD for which other risk factors such as radiation or nephrotoxic drug exposure may play a role.
Collapse
Affiliation(s)
- I G Glezerman
- Department of Medicine, Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - S Devlin
- Department of Epidemiology Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Maloy
- Department of Medicine, Adult Bone Marrow Transplant Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Bui
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - E A Jaimes
- Department of Medicine, Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - S A Giralt
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.,Department of Medicine, Adult Bone Marrow Transplant Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A A Jakubowski
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.,Department of Medicine, Adult Bone Marrow Transplant Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
49
|
Lundqvist A, van Hoef V, Zhang X, Wennerberg E, Lorent J, Witt K, Sanz LM, Liang S, Murray S, Larsson O, Kiessling R, Mao Y, Sidhom JW, Bessell CA, Havel J, Schneck J, Chan TA, Sachsenmeier E, Woods D, Berglund A, Ramakrishnan R, Sodre A, Weber J, Zappasodi R, Li Y, Qi J, Wong P, Sirard C, Postow M, Newman W, Koon H, Velcheti V, Callahan MK, Wolchok JD, Merghoub T, Lum LG, Choi M, Thakur A, Deol A, Dyson G, Shields A, Haymaker C, Uemura M, Murthy R, James M, Wang D, Brevard J, Monaghan C, Swann S, Geib J, Cornfeld M, Chunduru S, Agrawal S, Yee C, Wargo J, Patel SP, Amaria R, Tawbi H, Glitza I, Woodman S, Hwu WJ, Davies MA, Hwu P, Overwijk WW, Bernatchez C, Diab A, Massarelli E, Segal NH, Ribrag V, Melero I, Gangadhar TC, Urba W, Schadendorf D, Ferris RL, Houot R, Morschhauser F, Logan T, Luke JJ, Sharfman W, Barlesi F, Ott PA, Mansi L, Kummar S, Salles G, Carpio C, Meier R, Krishnan S, McDonald D, Maurer M, Gu X, Neely J, Suryawanshi S, Levy R, Khushalani N, Wu J, Zhang J, Basher F, Rubinstein M, Bucsek M, Qiao G, Hembrough T, Spacek J, Vocka M, Zavadova E, Skalova H, Dundr P, Petruzelka L, Francis N, Tilman RT, Hartmann A, MacDonald C, Netikova I, Ballesteros-Merino C, Stump J, Tufman A, Berger F, Neuberger M, Hatz R, Lindner M, Sanborn RE, Handy J, Hylander B, Fox B, Bifulco C, Huber RM, Winter H, Reu S, Sun C, Xiao W, Tian Z, Arora K, Desai N, Repasky E, Kulkarni A, Rajurkar M, Rivera M, Deshpande V, Ting D, Tsai K, Nosrati A, Goldinger S, Hamid O, Algazi A, Chatterjee S, Tumeh P, Hwang J, Liu J, Chen L, Dummer R, Rosenblum M, Daud A, Tsao TS, Ashworth-Sharpe J, Johnson D, Daenthanasanmak A, Bhaumik S, Bieniarz C, Couto J, Farrell M, Ghaffari M, Habensus I, Hubbard A, Jones T, Kelly B, Kosmeder J, Chakraborty P, Lee C, Marner E, Meridew J, Polaske N, Racolta A, Uribe D, Zhang H, Zhang J, Zhang W, Zhu Y, Toth K, Morrison L, Pestic-Dragovich L, Tang L, Tsujikawa T, Borkar RN, Azimi V, Kumar S, Thibault G, Mori M, El Rassi E, Meek M, Clayburgh DR, Kulesz-Martin MF, Flint PW, Coussens LM, Villabona L, Masucci GV, Geiss G, Birditt B, Mei Q, Huang A, Garrett-Mayer E, White AM, Eagan MA, Ignacio E, Elliott N, Dunaway D, Dennis L, Warren S, Beechem J, Dunaway D, Jung J, Nishimura M, Merritt C, Sprague I, Webster P, Liang Y, Warren S, Beechem J, Wenthe J, Enblad G, Karlsson H, Essand M, Paulos C, Savoldo B, Dotti G, Höglund M, Brenner MK, Hagberg H, Loskog A, Bernett MJ, Moore GL, Hedvat M, Bonzon C, Beeson C, Chu S, Rashid R, Avery KN, Muchhal U, Desjarlais J, Hedvat M, Bernett MJ, Moore GL, Bonzon C, Rashid R, Yu X, Chu S, Avery KN, Muchhal U, Desjarlais J, Kraman M, Kmiecik K, Allen N, Faroudi M, Zimarino C, Wydro M, Mehrotra S, Doody J, Srinivasa SP, Govindappa N, Reddy P, Dubey A, Periyasamy S, Adekandi M, Dey C, Joy M, van Loo PF, Zhao F, Veninga H, Shamsili S, Throsby M, Dolstra H, Bakker L, Alva A, Gschwendt J, Loriot Y, Bellmunt J, Feng D, Evans K, Poehlein C, Powles T, Antonarakis ES, Drake CG, Wu H, Poehlein C, De Bono J, Bannerji R, Byrd J, Gregory G, Xiao C, Opat S, Shortt J, Yee AJ, Raje N, Thompson S, Balakumaran A, Kumar S, Rini BI, Choueiri TK, Mariani M, Holtzhausen A, Albiges L, Haanen JB, Atkins MB, Larkin J, Schmidinger M, Magazzù D, di Pietro A, Motzer RJ, Borch TH, Andersen R, Hanks BA, Kongsted P, Pedersen M, Nielsen M, Met Ö, Donia M, Svane IM, Boudadi K, Wang H, Vasselli J, Baughman JE, Scharping N, Wigginton J, Abdallah R, Ross A, Drake CG, Antonarakis ES, Canter RJ, Park J, Wang Z, Grossenbacher S, Luna JI, Menk AV, Withers S, Culp W, Chen M, Monjazeb A, Kent MS, Murphy WJ, Chandran S, Somerville R, Wunderlich J, Danforth D, Moreci R, Yang J, Sherry R, Klebanoff C, Goff S, Paria B, Sabesan A, Srivastava A, Rosenberg SA, Kammula U, Curti B, Whetstone R, Richards J, Faries M, Andtbacka RHI, Grose M, Shafren D, Diaz LA, Le DT, Yoshino T, André T, Bendell J, Dadey R, Koshiji M, Zhang Y, Kang SP, Lam B, Jäger D, Bauer TM, Wang JS, Lee JK, Manji GA, Kudchadkar R, Watkins S, Kauh JS, Tang S, Laing N, Falchook G, Garon EB, Halmos B, Rina H, Leighl N, Lee SS, Walsh W, Ferris R, Dragnev K, Piperdi B, Rodriguez LPA, Shinwari N, Wei Z, Gustafson MP, Maas ML, Deeds M, Armstrong A, Bornschlegl S, Delgoffe GM, Peterson T, Steinmetz S, Gastineau DA, Parney IF, Dietz AB, Herzog T, Backes FJ, Copeland L, Del Pilar Estevez Diz M, Hare TW, Peled J, Huh W, Kim BG, Moore KM, Oaknin A, Small W, Tewari KS, Monk BJ, Kamat AM, Bellmunt J, Choueiri TK, Devlin S, Nam K, De Santis M, Dreicer R, Hahn NM, Perini R, Siefker-Radtke A, Sonpavde G, de Wit R, Witjes JA, Keefe S, Staffas A, Bajorin D, Kline J, Armand P, Kuruvilla J, Moskowitz C, Hamadani M, Ribrag V, Zinzani PL, Chlosta S, Thompson S, Lumish M, Balakumaran A, Bartlett N, Kyi C, Sabado R, Saenger Y, William L, Donovan MJ, Sacris E, Mandeli J, Salazar AM, Rodriguez KP, Friedlander P, Bhardwaj N, Powderly J, Brody J, Nemunaitis J, Emens L, Luke JJ, Patnaik A, McCaffery I, Miller R, Ahr K, Laport G, Coveler AL, Smith DC, Grilley-Olson JE, Gajewski TF, Goel S, Gardai SJ, Law CL, Means G, Manley T, Perales M, Curti B, Marrone KA, Rosner G, Anagnostou V, Riemer J, Wakefield J, Zanhow C, Baylin S, Gitlitz B, Brahmer J, Giralt S, McDermott DF, Signoretti S, Li W, Schloss C, Michot JM, Armand P, Ding W, Ribrag V, Christian B, Balakumaran A, Taur Y, Marinello P, Chlosta S, Zhang Y, Shipp M, Zinzani PL, Najjar YG, Lin, Butterfield LH, Tarhini AA, Davar D, Pamer E, Zarour H, Rush E, Sander C, Kirkwood JM, Fu S, Bauer T, Molineaux C, Bennett MK, Orford KW, Papadopoulos KP, van den Brink MRM, Padda SK, Shah SA, Colevas AD, Narayanan S, Fisher GA, Supan D, Wakelee HA, Aoki R, Pegram MD, Villalobos VM, Jenq R, Liu J, Takimoto CH, Chao M, Volkmer JP, Majeti R, Weissman IL, Sikic BI, Page D, Yu W, Conlin A, Annels N, Ruzich J, Lewis S, Acheson A, Kemmer K, Perlewitz K, Moxon NM, Mellinger S, Bifulco C, Martel M, Koguchi Y, Pandha H, Fox B, Urba W, McArthur H, Pedersen M, Westergaard MCW, Borch TH, Nielsen M, Kongsted P, Juhler-Nøttrup T, Donia M, Simpson G, Svane IM, Desai J, Markman B, Sandhu S, Gan H, Friedlander ML, Tran B, Meniawy T, Lundy J, Colyer D, Mostafid H, Ameratunga M, Norris C, Yang J, Li K, Wang L, Luo L, Qin Z, Mu S, Tan X, Song J, Harrington K, Millward M, Katz MHG, Bauer TW, Varadhachary GR, Acquavella N, Merchant N, Petroni G, Slingluff CL, Rahma OE, Rini BI, Melcher A, Powles T, Chen M, Song Y, Puhlmann M, Atkins MB, Sathyanaryanan S, Hirsch HA, Shu J, Deshpande A, Khattri A, Grose M, Reeves J, Zi T, Brisson R, Harvey C, Michaelson J, Law D, Seiwert T, Shah J, Mateos MV, Matsumoto M, Davies B, Blacklock H, Rocafiguera AO, Goldschmidt H, Iida S, Yehuda DB, Ocio E, Rodríguez-Otero P, Jagannath S, Lonial S, Kher U, Au G, Marinello P, San-Miguel J, Shah J, Lonial S, de Oliveira MR, Yimer H, Mateos MV, Rifkin R, Schjesvold F, Ocio E, Karpathy R, Rodríguez-Otero P, San-Miguel J, Ghori R, Marinello P, Jagannath S, Spreafico A, Lee V, Ngan RKC, To KF, Ahn MJ, Shafren D, Ng QS, Hong RL, Lin JC, Swaby RF, Gause C, Saraf S, Chan ATC, Lam E, Tannir NM, Meric-Bernstam F, Ricca J, Vaishampayan U, Orford KW, Molineaux C, Gross M, MacKinnon A, Whiting S, Voss M, Yu EY, Wu H, Schloss C, Merghoub T, Albertini MR, Ranheim EA, Hank JA, Zuleger C, McFarland T, Collins J, Clements E, Weber S, Weigel T, Neuman H, Wolchok JD, Hartig G, Mahvi D, Henry M, Gan J, Yang R, Carmichael L, Kim K, Gillies SD, Sondel PM, Subbiah V, Zamarin D, Murthy R, Noffsinger L, Hendricks K, Bosch M, Lee JM, Lee MH, Garon EB, Goldman JW, Baratelli FE, Schaue D, Batista L, Wang G, Rosen F, Yanagawa J, Walser TC, Lin YQ, Adams S, Marincola FM, Tumeh PC, Abtin F, Suh R, Marliot F, Reckamp K, Wallace WD, Zeng G, Elashoff DA, Sharma S, Dubinett SM, Bhardwaj N, Friedlander P, Pavlick AC, Ernstoff MS, Vasaturo A, Gastman B, Hanks B, Albertini MR, Luke JJ, Keler T, Davis T, Vitale LA, Sharon E, Danaher P, Morishima C, Carpentier S, Cheever M, Fling S, Heery CR, Kim JW, Lamping E, Marte J, McMahon S, Cordes L, Fakhrejahani F, Madan R, Poggionovo C, Tsang K, Jochems C, Salazar R, Zhang M, Helwig C, Schlom J, Gulley JL, Li R, Amrhein J, Cohen Z, Frayssinet V, Champagne M, Kamat A, Aznar MA, Labiano S, Diaz-Lagares A, Esteller M, Sandoval J, Melero I, Barbee SD, Bellovin DI, Fieschi J, Timmer JC, Wondyfraw N, Johnson S, Park J, Chen A, Mkrtichyan M, Razai AS, Jones KS, Hata CY, Gonzalez D, Van den Eynde M, Deveraux Q, Eckelman BP, Borges L, Bhardwaj R, Puri RK, Suzuki A, Leland P, Joshi BH, Bartkowiak T, Jaiswal A, Pagès F, Ager C, Ai M, Budhani P, Chin R, Hong D, Curran M, Hastings WD, Pinzon-Ortiz M, Murakami M, Dobson JR, Galon J, Quinn D, Wagner JP, Rong X, Shaw P, Dammassa E, Guan W, Dranoff G, Cao A, Fulton RB, Leonardo S, Hermitte F, Fraser K, Kangas TO, Ottoson N, Bose N, Huhn RD, Graff J, Lowe J, Gorden K, Uhlik M, Vitale LA, Smith SG, O’Neill T, Widger J, Crocker A, He LZ, Weidlick J, Sundarapandiyan K, Ramakrishna V, Storey J, Thomas LJ, Goldstein J, Nguyen K, Marsh HC, Keler T, Grailer J, Gilden J, Stecha P, Garvin D, Hartnett J, Fan F, Cong M, Cheng ZJJ, Ravindranathan S, Hinner MJ, Aiba RSB, Schlosser C, Jaquin T, Allersdorfer A, Berger S, Wiedenmann A, Matschiner G, Schüler J, Moebius U, Koppolu B, Rothe C, Shane OA, Horton B, Spranger S, Gajewski TF, Moreira D, Adamus T, Zhao X, Swiderski P, Pal S, Zaharoff D, Kortylewski M, Kosmides A, Necochea K, Schneck J, Mahoney KM, Shukla SA, Patsoukis N, Chaudhri A, Pham H, Hua P, Schvartsman G, Bu X, Zhu B, Hacohen N, Wu CJ, Fritsch E, Boussiotis VA, Freeman GJ, Moran AE, Polesso F, Lukaesko L, Bassett R, Weinberg A, Rådestad E, Egevad L, Mattsson J, Sundberg B, Henningsohn L, Levitsky V, Uhlin M, Rafelson W, Reagan JL, McQuade JL, Fast L, Sasikumar P, Sudarshan N, Ramachandra R, Gowda N, Samiulla D, Chandrasekhar T, Adurthi S, Mani J, Nair R, Haydu LE, Dhudashia A, Gowda N, Ramachandra M, Sankin A, Gartrell B, Cumberbatch K, Huang H, Stern J, Schoenberg M, Zang X, Davies MA, Swanson R, Kornacker M, Evans L, Rickel E, Wolfson M, Valsesia-Wittmann S, Shekarian T, Simard F, Nailo R, Dutour A, Tawbi H, Jallas AC, Caux C, Marabelle A, Glitza I, Kline D, Chen X, Fosco D, Kline J, Overacre A, Chikina M, Brunazzi E, Shayan G, Horne W, Kolls J, Ferris RL, Delgoffe GM, Bruno TC, Workman C, Vignali D, Adusumilli PS, Ansa-Addo EA, Li Z, Gerry A, Sanderson JP, Howe K, Docta R, Gao Q, Bagg EAL, Tribble N, Maroto M, Betts G, Bath N, Melchiori L, Lowther DE, Ramachandran I, Kari G, Basu S, Binder-Scholl G, Chagin K, Pandite L, Holdich T, Amado R, Zhang H, Glod J, Bernstein D, Jakobsen B, Mackall C, Wong R, Silk JD, Adams K, Hamilton G, Bennett AD, Brett S, Jing J, Quattrini A, Saini M, Wiedermann G, Gerry A, Jakobsen B, Binder-Scholl G, Brewer J, Duong M, Lu A, Chang P, Mahendravada A, Shinners N, Slawin K, Spencer DM, Foster AE, Bayle JH, Bergamaschi C, Ng SSM, Nagy B, Jensen S, Hu X, Alicea C, Fox B, Felber B, Pavlakis G, Chacon J, Yamamoto T, Garrabrant T, Cortina L, Powell DJ, Donia M, Kjeldsen JW, Andersen R, Westergaard MCW, Bianchi V, Legut M, Attaf M, Dolton G, Szomolay B, Ott S, Lyngaa R, Hadrup SR, Sewell AK, Svane IM, Fan A, Kumai T, Celis E, Frank I, Stramer A, Blaskovich MA, Wardell S, Fardis M, Bender J, Lotze MT, Goff SL, Zacharakis N, Assadipour Y, Prickett TD, Gartner JJ, Somerville R, Black M, Xu H, Chinnasamy H, Kriley I, Lu L, Wunderlich J, Robbins PF, Rosenberg S, Feldman SA, Trebska-McGowan K, Kriley I, Malekzadeh P, Payabyab E, Sherry R, Rosenberg S, Goff SL, Gokuldass A, Blaskovich MA, Kopits C, Rabinovich B, Lotze MT, Green DS, Kamenyeva O, Zoon KC, Annunziata CM, Hammill J, Helsen C, Aarts C, Bramson J, Harada Y, Yonemitsu Y, Helsen C, Hammill J, Mwawasi K, Denisova G, Bramson J, Giri R, Jin B, Campbell T, Draper LM, Stevanovic S, Yu Z, Weissbrich B, Restifo NP, Trimble CL, Rosenberg S, Hinrichs CS, Tsang K, Fantini M, Hodge JW, Fujii R, Fernando I, Jochems C, Heery C, Gulley J, Soon-Shiong P, Schlom J, Jing W, Gershan J, Blitzer G, Weber J, McOlash L, Johnson BD, Kiany S, Gangxiong H, Kleinerman ES, Klichinsky M, Ruella M, Shestova O, Kenderian S, Kim M, Scholler J, June CH, Gill S, Moogk D, Zhong S, Yu Z, Liadi I, Rittase W, Fang V, Dougherty J, Perez-Garcia A, Osman I, Zhu C, Varadarajan N, Restifo NP, Frey A, Krogsgaard M, Landi D, Fousek K, Mukherjee M, Shree A, Joseph S, Bielamowicz K, Byrd T, Ahmed N, Hegde M, Lee S, Byrd D, Thompson J, Bhatia S, Tykodi S, Delismon J, Chu L, Abdul-Alim S, Ohanian A, DeVito AM, Riddell S, Margolin K, Magalhaes I, Mattsson J, Uhlin M, Nemoto S, Villarroel PP, Nakagawa R, Mule JJ, Mailloux AW, Mata M, Nguyen P, Gerken C, DeRenzo C, Spencer DM, Gottschalk S, Mathieu M, Pelletier S, Stagg J, Turcotte S, Minutolo N, Sharma P, Tsourkas A, Powell DJ, Mockel-Tenbrinck N, Mauer D, Drechsel K, Barth C, Freese K, Kolrep U, Schult S, Assenmacher M, Kaiser A, Mullinax J, Hall M, Le J, Kodumudi K, Royster E, Richards A, Gonzalez R, Sarnaik A, Pilon-Thomas S, Nielsen M, Krarup-Hansen A, Hovgaard D, Petersen MM, Loya AC, Junker N, Svane IM, Rivas C, Parihar R, Gottschalk S, Rooney CM, Qin H, Nguyen S, Su P, Burk C, Duncan B, Kim BH, Kohler ME, Fry T, Rao AA, Teyssier N, Pfeil J, Sgourakis N, Salama S, Haussler D, Richman SA, Nunez-Cruz S, Gershenson Z, Mourelatos Z, Barrett D, Grupp S, Milone M, Rodriguez-Garcia A, Robinson MK, Adams GP, Powell DJ, Santos J, Havunen R, Siurala M, Cervera-Carrascón V, Parviainen S, Antilla M, Hemminki A, Sethuraman J, Santiago L, Chen JQ, Dai Z, Wardell S, Bender J, Lotze MT, Sha H, Su S, Ding N, Liu B, Stevanovic S, Pasetto A, Helman SR, Gartner JJ, Prickett TD, Robbins PF, Rosenberg SA, Hinrichs CS, Bhatia S, Burgess M, Zhang H, Lee T, Klingemann H, Soon-Shiong P, Nghiem P, Kirkwood JM, Rossi JM, Sherman M, Xue A, Shen YW, Navale L, Rosenberg SA, Kochenderfer JN, Bot A, Veerapathran A, Gokuldass A, Stramer A, Sethuraman J, Blaskovich MA, Wiener D, Frank I, Santiago L, Rabinovich B, Fardis M, Bender J, Lotze MT, Waller EK, Li JM, Petersen C, Blazar BR, Li J, Giver CR, Wang Z, Grossenbacher SK, Sturgill I, Canter RJ, Murphy WJ, Zhang C, Burger MC, Jennewein L, Waldmann A, Mittelbronn M, Tonn T, Steinbach JP, Wels WS, Williams JB, Zha Y, Gajewski TF, Williams LC, Krenciute G, Kalra M, Louis C, Gottschalk S, Xin G, Schauder D, Jiang A, Joshi N, Cui W, Zeng X, Menk AV, Scharping N, Delgoffe GM, Zhao Z, Hamieh M, Eyquem J, Gunset G, Bander N, Sadelain M, Askmyr D, Abolhalaj M, Lundberg K, Greiff L, Lindstedt M, Angell HK, Kim KM, Kim ST, Kim S, Sharpe AD, Ogden J, Davenport A, Hodgson DR, Barrett C, Lee J, Kilgour E, Hanson J, Caspell R, Karulin A, Lehmann P, Ansari T, Schiller A, Sundararaman S, Lehmann P, Hanson J, Roen D, Karulin A, Lehmann P, Ayers M, Levitan D, Arreaza G, Liu F, Mogg R, Bang YJ, O’Neil B, Cristescu R, Friedlander P, Wassman K, Kyi C, Oh W, Bhardwaj N, Bornschlegl S, Gustafson MP, Gastineau DA, Parney IF, Dietz AB, Carvajal-Hausdorf D, Mani N, Velcheti V, Schalper K, Rimm D, Chang S, Levy R, Kurland J, Krishnan S, Ahlers CM, Jure-Kunkel M, Cohen L, Maecker H, Kohrt H, Chen S, Crabill G, Pritchard T, McMiller T, Pardoll D, Pan F, Topalian S, Danaher P, Warren S, Dennis L, White AM, D’Amico L, Geller M, Disis ML, Beechem J, Odunsi K, Fling S, Derakhshandeh R, Webb TJ, Dubois S, Conlon K, Bryant B, Hsu J, Beltran N, Müller J, Waldmann T, Duhen R, Duhen T, Thompson L, Montler R, Weinberg A, Kates M, Early B, Yusko E, Schreiber TH, Bivalacqua TJ, Ayers M, Lunceford J, Nebozhyn M, Murphy E, Loboda A, Kaufman DR, Albright A, Cheng J, Kang SP, Shankaran V, Piha-Paul SA, Yearley J, Seiwert T, Ribas A, McClanahan TK, Cristescu R, Mogg R, Ayers M, Albright A, Murphy E, Yearley J, Sher X, Liu XQ, Nebozhyn M, Lunceford J, Joe A, Cheng J, Plimack E, Ott PA, McClanahan TK, Loboda A, Kaufman DR, Forrest-Hay A, Guyre CA, Narumiya K, Delcommenne M, Hirsch HA, Deshpande A, Reeves J, Shu J, Zi T, Michaelson J, Law D, Trehu E, Sathyanaryanan S, Hodkinson BP, Hutnick NA, Schaffer ME, Gormley M, Hulett T, Jensen S, Ballesteros-Merino C, Dubay C, Afentoulis M, Reddy A, David L, Fox B, Jayant K, Agrawal S, Agrawal R, Jeyakumar G, Kim S, Kim H, Silski C, Suisham S, Heath E, Vaishampayan U, Vandeven N, Viller NN, O’Connor A, Chen H, Bossen B, Sievers E, Uger R, Nghiem P, Johnson L, Kao HF, Hsiao CF, Lai SC, Wang CW, Ko JY, Lou PJ, Lee TJ, Liu TW, Hong RL, Kearney SJ, Black JC, Landis BJ, Koegler S, Hirsch B, Gianani R, Kim J, He MX, Zhang B, Su N, Luo Y, Ma XJ, Park E, Kim DW, Copploa D, Kothari N, doo Chang Y, Kim R, Kim N, Lye M, Wan E, Kim N, Lye M, Wan E, Kim N, Lye M, Wan E, Knaus HA, Berglund S, Hackl H, Karp JE, Gojo I, Luznik L, Hong HS, Koch SD, Scheel B, Gnad-Vogt U, Kallen KJ, Wiegand V, Backert L, Kohlbacher O, Hoerr I, Fotin-Mleczek M, Billingsley JM, Koguchi Y, Conrad V, Miller W, Gonzalez I, Poplonski T, Meeuwsen T, Howells-Ferreira A, Rattray R, Campbell M, Bifulco C, Dubay C, Bahjat K, Curti B, Urba W, Vetsika EK, Kallergi G, Aggouraki D, Lyristi Z, Katsarlinos P, Koinis F, Georgoulias V, Kotsakis A, Martin NT, Aeffner F, Kearney SJ, Black JC, Cerkovnik L, Pratte L, Kim R, Hirsch B, Krueger J, Gianani R, Martínez-Usatorre A, Jandus C, Donda A, Carretero-Iglesia L, Speiser DE, Zehn D, Rufer N, Romero P, Panda A, Mehnert J, Hirshfield KM, Riedlinger G, Damare S, Saunders T, Sokol L, Stein M, Poplin E, Rodriguez-Rodriguez L, Silk A, Chan N, Frankel M, Kane M, Malhotra J, Aisner J, Kaufman HL, Ali S, Ross J, White E, Bhanot G, Ganesan S, Monette A, Bergeron D, Amor AB, Meunier L, Caron C, Morou A, Kaufmann D, Liberman M, Jurisica I, Mes-Masson AM, Hamzaoui K, Lapointe R, Mongan A, Ku YC, Tom W, Sun Y, Pankov A, Looney T, Au-Young J, Hyland F, Conroy J, Morrison C, Glenn S, Burgher B, Ji H, Gardner M, Mongan A, Omilian AR, Conroy J, Bshara W, Angela O, Burgher B, Ji H, Glenn S, Morrison C, Mongan A, Obeid JM, Erdag G, Smolkin ME, Deacon DH, Patterson JW, Chen L, Bullock TN, Slingluff CL, Obeid JM, Erdag G, Deacon DH, Slingluff CL, Bullock TN, Loffredo JT, Vuyyuru R, Beyer S, Spires VM, Fox M, Ehrmann JM, Taylor KA, Korman AJ, Graziano RF, Page D, Sanchez K, Ballesteros-Merino C, Martel M, Bifulco C, Urba W, Fox B, Patel SP, De Macedo MP, Qin Y, Reuben A, Spencer C, Guindani M, Bassett R, Wargo J, Racolta A, Kelly B, Jones T, Polaske N, Theiss N, Robida M, Meridew J, Habensus I, Zhang L, Pestic-Dragovich L, Tang L, Sullivan RJ, Logan T, Khushalani N, Margolin K, Koon H, Olencki T, Hutson T, Curti B, Roder J, Blackmon S, Roder H, Stewart J, Amin A, Ernstoff MS, Clark JI, Atkins MB, Kaufman HL, Sosman J, Weber J, McDermott DF, Weber J, Kluger H, Halaban R, Snzol M, Roder H, Roder J, Asmellash S, Steingrimsson A, Blackmon S, Sullivan RJ, Wang C, Roman K, Clement A, Downing S, Hoyt C, Harder N, Schmidt G, Schoenmeyer R, Brieu N, Yigitsoy M, Madonna G, Botti G, Grimaldi A, Ascierto PA, Huss R, Athelogou M, Hessel H, Harder N, Buchner A, Schmidt G, Stief C, Huss R, Binnig G, Kirchner T, Sellappan S, Thyparambil S, Schwartz S, Cecchi F, Nguyen A, Vaske C. 31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016): part one. J Immunother Cancer 2016. [PMCID: PMC5123387 DOI: 10.1186/s40425-016-0172-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
50
|
Ogunniyi A, Rodriguez M, Devlin S, Adel N, Landau H, Chung DJ, Lendvai N, Lesokhin A, Koehne G, Mailankody S, Korde N, Reich L, Landgren O, Giralt S, Hassoun H. Upfront use of plerixafor and granulocyte-colony stimulating factor (GCSF) for stem cell mobilization in patients with multiple myeloma: efficacy and analysis of risk factors associated with poor stem cell collection efficiency. Leuk Lymphoma 2016; 58:1123-1129. [PMID: 27735212 DOI: 10.1080/10428194.2016.1239261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Plerixafor (P), an agent that selectively and reversibly binds to the chemokine receptor CXCR4, has been approved in combination with G-CSF (P + G-CSF) for stem cell (SC) mobilization in patients with multiple myeloma (MM). The goal of this study was to determine the SC collection success rate of P + G-CSF using a clinically relevant outcome defined as the ability to collect at least 5 × 106 CD34+ cells/kg to allow safely two transplants, and identify risk factors impacting SC mobilization. One hundred and thirty-eight patients were mobilized with P + G-CSF upfront following induction. The SC collection success rate was 92.8%. We identified exposure to lenalidomide alone (p = .038), WBC count <4 × 103/mcL prior to mobilization (p = .01) and non-African American race (p = .019), as risk factors for low efficiency by multivariate analysis. This study demonstrates that P + G-CSF is highly efficient in MM patients and provides strong support for its upfront use in SC collection for MM patients.
Collapse
Affiliation(s)
- Adebayo Ogunniyi
- a Department of Pharmacy , Weill Cornell Medical College , New York , NY , USA
| | - Mabel Rodriguez
- a Department of Pharmacy , Weill Cornell Medical College , New York , NY , USA
| | - Sean Devlin
- b Department of Epidemiology and Biostatistics , Weill Cornell Medical College , New York , NY , USA
| | - Nelly Adel
- a Department of Pharmacy , Weill Cornell Medical College , New York , NY , USA
| | - Heather Landau
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| | - David J Chung
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| | - Nikoletta Lendvai
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| | - Alexander Lesokhin
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| | - Guenther Koehne
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| | - Sham Mailankody
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| | - Neha Korde
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| | - Lilian Reich
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| | - Ola Landgren
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| | - Sergio Giralt
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| | - Hani Hassoun
- c Department of Medicine , Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York , NY , USA
| |
Collapse
|