1
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Leithner D, Flynn JR, Devlin SM, Mauguen A, Fei T, Zeng S, Zheng J, Imber BS, Hubbeling H, Mayerhoefer ME, Bedmutha A, Luttwak E, Corona M, Dahi PB, Luna de Abia A, Landego I, Lin RJ, Palomba ML, Scordo M, Park JH, Tomas AA, Salles G, Lafontaine D, Michaud L, Shah GL, Perales MA, Shouval R, Schöder H. Conventional and novel [ 18F]FDG PET/CT features as predictors of CAR-T cell therapy outcome in large B-cell lymphoma. J Hematol Oncol 2024; 17:21. [PMID: 38649972 PMCID: PMC11035117 DOI: 10.1186/s13045-024-01540-x] [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: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
Relapse and toxicity limit the effectiveness of chimeric antigen receptor T-cell (CAR-T) therapy for large B-cell lymphoma (LBCL), yet biomarkers that predict outcomes and toxicity are lacking. We examined radiomic features extracted from pre-CAR-T 18F-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) scans (n = 341) of 180 patients (121 male; median age, 66 years). Three conventional (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], total lesion glycolysis [TLG]) and 116 novel radiomic features were assessed, along with inflammatory markers, toxicities, and outcomes. At both pre-apheresis and pre-infusion time points, conventional PET features of disease correlated with elevated inflammatory markers. At pre-infusion, MTV was associated with grade ≥ 2 cytokine release syndrome (odds ratio [OR] for 100 mL increase: 1.08 [95% confidence interval (CI), 1.01-1.20], P = 0.031), and SUVmax was associated with failure to achieve complete response (CR) (OR 1.72 [95% CI, 1.24-2.43], P < 0.001). Higher pre-apheresis and pre-infusion MTV values were associated with shorter progression-free survival (PFS) (HR for 10-unit increase: 1.11 [95% CI, 1.05-1.17], P < 0.001; 1.04 [95% CI, 1.02-1.07], P < 0.001) and shorter overall survival (HR for 100-unit increase: 1.14 [95% CI, 1.07-1.21], P < 0.001; 1.04 [95% CI, 1.02-1.06], P < 0.001). A combined MTV and LDH measure stratified patients into high and low PFS risk groups. Multiple pre-infusion novel radiomic features were associated with CR. These quantitative conventional [18F]FDG PET/CT features obtained before CAR-T cell infusion, which were correlated with inflammation markers, may provide prognostic biomarkers for CAR-T therapy efficacy and toxicity. The use of conventional and novel radiomic features may thus help identify high-risk patients for earlier interventions.
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Affiliation(s)
- Doris Leithner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, USA
| | - Jessica R Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Teng Fei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shang Zeng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brandon S Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Harper Hubbeling
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marius E Mayerhoefer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, USA
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Akshay Bedmutha
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Efrat Luttwak
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Magdalena Corona
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, 530 E74th Street, NY, 10021, New York, USA
- Hematology and Hemotherapy Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Parastoo B Dahi
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, 530 E74th Street, NY, 10021, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Alejandro Luna de Abia
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, 530 E74th Street, NY, 10021, New York, USA
- Bone Marrow Transplantation Unit, Hematology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ivan Landego
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, 530 E74th Street, NY, 10021, New York, USA
| | - Richard J Lin
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, 530 E74th Street, NY, 10021, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - M Lia Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Michael Scordo
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, 530 E74th Street, NY, 10021, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jae H Park
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ana Alarcon Tomas
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, 530 E74th Street, NY, 10021, New York, USA
- Department of Hematology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Gilles Salles
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Daniel Lafontaine
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Laure Michaud
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Nuclear Medicine and Molecular ImagingLausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Gunjan L Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, 530 E74th Street, NY, 10021, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, 530 E74th Street, NY, 10021, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Roni Shouval
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, 530 E74th Street, NY, 10021, New York, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
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2
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Fingrut WB, Davis E, Archer A, Brown S, Devlin SM, Nhaissi M, Rapoport C, Chinapen S, Kelly A, Wells DS, Scaradavou A, Gyurkocza B, Papadopoulos EB, Politikos I, Shaffer BC, Barker J. Racial/ ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation. Blood Adv 2024:bloodadvances.2023012385. [PMID: 38429097 DOI: 10.1182/bloodadvances.2023012385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/22/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024] Open
Abstract
Despite the global unrelated donor (URD) registry size, the degree to which URD availability is a transplant barrier is not established. We evaluated the availability of 3,843 URDs requested for 455 diverse adult patients (predominantly with acute leukemia). URDs for non-Europeans were more likely to be domestic and had markedly lower Donor Readiness Scores. Of URDs requested for confirmatory HLA-typing (CT) alone (i.e. without simultaneous workup), 1,894/3,529 (54%) were available. Availability of domestic URDs was 45%. Donor Readiness Score was highly predictive of CT availability. Compared with Europeans (n=335), more non-European patients (n=120) had >10 URDs requested and <5 available. Of workup requests (after CT or CT-workup), <70% (604/889, 68%) were available. More non-Europeans had <2 URDs available. URD availability for CT was markedly worse for non-Europeans, with availabilities for African, non-Black Hispanic, and Asian patients of 150/458 (33%), 120/258 (47%) and 119/270 (44%), respectively, with further decrements in URD workup availability. Our data suggest the functional size of the URD pool is much smaller than appreciated, mandating major operational changes for transplant Centers and donor registries. Likelihood of donor availability should have a high priority in donor selection. Considering patient ancestry and URD Donor Readiness Scores, Centers should pursue, and registries permit, simultaneous pursuit of many URDs, and abandon futile searches. Patients should be informed about their likelihood of donor availability and alternative options. Finally, while registries should address high URD attrition and speed procurement, use of all HLA-disparate graft types is needed to facilitate timely transplantation for all.
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Affiliation(s)
- Warren B Fingrut
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Eric Davis
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Anne Archer
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Samantha Brown
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Sean M Devlin
- Memorial Sloan-Kettering Cancer Center, New York, New York, United States
| | - Melissa Nhaissi
- Memorial Sloan Kettering Cancer Center, NY, New York, United States
| | - Candice Rapoport
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Stephanie Chinapen
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Amanda Kelly
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Deborah S Wells
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | | | | | - Ioannis Politikos
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Brian C Shaffer
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Juliet Barker
- Weill Cornell Medicine, New York, New York, United States
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3
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Stonestrom AJ, Menghrajani KN, Devlin SM, Franch-Expósito S, Ptashkin RN, Patel SY, Spitzer B, Wu X, Jee J, Sánchez Vela P, Milbank JH, Shah RH, Mohanty AS, Brannon AR, Xiao W, Berger MF, Mantha S, Levine RL. High-risk and silent clonal hematopoietic genotypes in patients with nonhematologic cancer. Blood Adv 2024; 8:846-856. [PMID: 38147626 PMCID: PMC10875331 DOI: 10.1182/bloodadvances.2023011262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
ABSTRACT Clonal hematopoiesis (CH) identified by somatic gene variants with variant allele fraction (VAF) ≥ 2% is associated with an increased risk of hematologic malignancy. However, CH defined by a broader set of genotypes and lower VAFs is ubiquitous in older individuals. To improve our understanding of the relationship between CH genotype and risk of hematologic malignancy, we analyzed data from 42 714 patients who underwent blood sequencing as a normal comparator for nonhematologic tumor testing using a large cancer-related gene panel. We cataloged hematologic malignancies in this cohort using natural language processing and manual curation of medical records. We found that some CH genotypes including JAK2, RUNX1, and XPO1 variants were associated with high hematologic malignancy risk. Chronic disease was predicted better than acute disease suggesting the influence of length bias. To better understand the implications of hematopoietic clonality independent of mutational function, we evaluated a set of silent synonymous and noncoding mutations. We found that silent CH, particularly when multiple variants were present or VAF was high, was associated with increased risk of hematologic malignancy. We tracked expansion of CH mutations in 26 hematologic malignancies sequenced with the same platform. JAK2 and TP53 VAF consistently expanded at disease onset, whereas DNMT3A and silent CH VAFs mostly decreased. These data inform the clinical and biological interpretation of CH in the context of nonhematologic cancer.
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Affiliation(s)
- Aaron J. Stonestrom
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kamal N. Menghrajani
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M. Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sebastià Franch-Expósito
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ryan N. Ptashkin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Barbara Spitzer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Xiaodi Wu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Justin Jee
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pablo Sánchez Vela
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer H. Milbank
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ronak H. Shah
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abhinita S. Mohanty
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A. Rose Brannon
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wenbin Xiao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael F. Berger
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Simon Mantha
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ross L. Levine
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
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4
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Dahi PB, Kenny S, Flynn J, Devlin SM, Ruiz JD, Chinapen SA, Lahoud OB, Matasar MJ, Moskowitz CH, Perales MA, Shah G, Sauter CS, Giralt SA, Geyer AI, Jakubowski AA. Utility of routine pulmonary function test after autologous hematopoietic cell transplantation in lymphoma. Leuk Lymphoma 2023; 64:2279-2285. [PMID: 37690007 PMCID: PMC10981269 DOI: 10.1080/10428194.2023.2256912] [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: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
This study aims to evaluate the predictive value of routine pulmonary function testing (PFT) at the 12-month mark post-autologous hematopoietic cell transplant (AHCT) in identifying clinically significant lung disease in lymphoma survivors. In 247 patients, 173 (70%) received BEAM (carmustine, etoposide, cytarabine, melphalan), and 49 (20%) received TBC (thiotepa, busulfan, cyclophosphamide) conditioning regimens. Abnormal baseline PFT was noted in 149 patients (60%). Thirty-four patients had a significant decline (reduction of >/= 20% in DLCO or FEV1 or FVC) in post-AHCT PFT, with the highest incidence in the CNS lymphoma group (39%). The incidence of clinically significant lung disease post-transplant was low at 2% and there was no association between abnormal pre- and 1-year post-transplant PFTs with the development of clinical lung disease. While this study illustrates the impact of treatment regimens on PFT changes, it did not demonstrate a predictive value of scheduled PFTs in identifying clinically significant post-AHCT lung disease.
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Affiliation(s)
- Parastoo B. Dahi
- 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
| | - Sheila Kenny
- Adult Bone Marrow Transplantation 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
| | - Sean M. Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josel D. Ruiz
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie A. Chinapen
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar B. Lahoud
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Craig H. Moskowitz
- Hematology, University of Miami Health System, Sylvester Comprehensive Cancer Center, Miami, FL
| | - 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
| | - 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
| | - Craig S. Sauter
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - 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
| | - Alexander I. Geyer
- Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 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
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5
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Nath K, Lee J, Elko TA, Levy L, Preston E, Devlin SM, Ponce DM, Lin RJ, Shaffer BC, Cho C, Politikos I, Jakubowski AA, Park JH, Rampal R, Perales MA, Tallman MS, Barker JN, Berman E, Tamari R, Stein E, Giralt SA, Gyurkocza B. Prospective analysis to determine barriers to allogeneic hematopoietic cell transplantation in patients with acute leukemia. Am J Hematol 2023; 98:1869-1876. [PMID: 37688521 PMCID: PMC10697699 DOI: 10.1002/ajh.27084] [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: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment for patients with acute leukemia. Despite this, studies have shown that only a minority of patients ultimately proceed to allo-HCT. The primary objective of this prospective, observational study was to identify the rate of allo-HCT in patients for whom it was recommended, and reasons why patients deemed appropriate and eligible for HCT did not subsequently undergo transplant. Between April 2016 and April 2021, adult patients with newly diagnosed or relapsed/refractory acute leukemia were enrolled at the time of induction/reinduction therapy. Initial transplantation workup and allo-HCT recommendations were made during the early phase of induction/reinduction. Of the 307 enrolled patients, allo-HCT was recommended to 85% (n = 259), of whom 66% (n = 170) underwent transplant. Donor sources comprised 54% human leukocyte antigen (HLA)-matched unrelated donors, 20% HLA-matched sibling donors and HLA-mismatched graft sources with 15% umbilical cord blood units, 8% HLA-mismatched unrelated donors, and 4% HLA-haploidentical donors. The most common reason for transplant disqualification in the 89 patients in whom it was initially recommended was persistent/relapsed disease (70%), followed by early patient death (10%). In this prospective study, we report a high allo-HCT rate, which may be due to early transplant referral and workup. The main allo-HCT barrier was disease control, followed by early patient death. With the increasing availability of HLA-mismatched graft sources, the lack of donor availability was not a transplant barrier. Further development of novel transplant strategies for patients not achieving remission and improvements in induction regimens could result in increased allo-HCT utilization.
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Affiliation(s)
- Karthik Nath
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jasme Lee
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theresa A Elko
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lauren Levy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elaina Preston
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M. Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Doris M Ponce
- 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
| | - Richard J. Lin
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- 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
| | - Brian C. Shaffer
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- 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
| | - Christina Cho
- 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
| | - Ioannis Politikos
- 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
| | - Ann A 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
| | - Jae H Park
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raajit Rampal
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Miguel-Angel Perales
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- 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
| | - Martin S. Tallman
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 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 Medical College, New York, NY
| | - Ellin Berman
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 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 Medical College, New York, NY
| | - Eytan Stein
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio A Giralt
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- 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
| | - Boglarka 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
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6
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Elias S, Brown S, Devlin SM, Barker JN, Cho C, Chung DJ, Dahi PB, Giralt S, Gyurkocza B, Jakubowski AA, Lahoud OB, Landau H, Lin RJ, Papadopoulos EB, Politikos I, Ponce DM, Scordo M, Shaffer BC, Shah GL, Tamari R, Young JW, Perales MA, Shouval R. The Simplified Comorbidity Index predicts non-relapse mortality in reduced-intensity conditioning allogeneic haematopoietic cell transplantation. Br J Haematol 2023; 203:840-851. [PMID: 37614192 PMCID: PMC10843799 DOI: 10.1111/bjh.19055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
Comorbidity assessment before allogeneic haematopoietic cell transplantation (allo-HCT) is essential for estimating non-relapse mortality (NRM) risk. We previously developed the Simplified Comorbidity Index (SCI), which captures a small number of 'high-yield' comorbidities and older age. The SCI was predictive of NRM in myeloablative CD34-selected allo-HCT. Here, we evaluated the SCI in a single-centre cohort of 327 patients receiving reduced-intensity conditioning followed by unmanipulated allografts from HLA-matched donors. Among the SCI factors, age above 60, mild renal impairment, moderate pulmonary disease and cardiac disease were most frequent. SCI scores ranged from 0 to 8, with 39%, 20%, 20% and 21% having scores of 0-1, 2, 3 and ≥4 respectively. Corresponding cumulative incidences of 3-year NRM were 11%, 16%, 22% and 27%; p = 0.03. In multivariable models, higher SCI scores were associated with incremental risks of all-cause mortality and NRM. The SCI had an area under the receiver operating characteristic curve of 65.9%, 64.1% and 62.9% for predicting 1-, 2- and 3-year NRM versus 58.4%, 60.4% and 59.3% with the haematopoietic cell transplantation comorbidity index. These results demonstrate for the first time that the SCI is predictive of NRM in patients receiving allo-HCT from HLA-matched donors after reduced-intensity conditioning.
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Affiliation(s)
- Shlomo Elias
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Bone Marrow Transplantation and Cancer Immunotherapy, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Samantha Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Juliet N Barker
- 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
| | - Christina Cho
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - David J Chung
- 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
| | - Parastoo B Dahi
- 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 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
| | - 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
| | - 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
| | - Oscar B Lahoud
- 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
| | - Heather Landau
- 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
| | - Richard J Lin
- 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
| | - 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
| | - Ioannis Politikos
- 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
| | - Doris M Ponce
- 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
| | - 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 L 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
| | - 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
| | - James W Young
- 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
- The Rockefeller University, 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
| | - Roni Shouval
- 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
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7
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Smith M, Dai A, Ghilardi G, Amelsberg KV, Devlin SM, Pajarillo R, Slingerland JB, Beghi S, Herrera PS, Giardina P, Clurman A, Dwomoh E, Armijo G, Gomes ALC, Littmann ER, Schluter J, Fontana E, Taur Y, Park JH, Palomba ML, Halton E, Ruiz J, Jain T, Pennisi M, Afuye AO, Perales MA, Freyer CW, Garfall A, Gier S, Nasta S, Landsburg D, Gerson J, Svoboda J, Cross J, Chong EA, Giralt S, Gill SI, Riviere I, Porter DL, Schuster SJ, Sadelain M, Frey N, Brentjens RJ, June CH, Pamer EG, Peled JU, Facciabene A, van den Brink MRM, Ruella M. Author Correction: Gut microbiome correlates of response and toxicity following anti-CD19 CAR T cell therapy. Nat Med 2023; 29:2954. [PMID: 36253610 DOI: 10.1038/s41591-022-02069-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Melody Smith
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University School of Medicine, Stanford, CA, USA
| | - Anqi Dai
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guido Ghilardi
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly V Amelsberg
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sean M Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymone Pajarillo
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - John B Slingerland
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Silvia Beghi
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela S Herrera
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Paul Giardina
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annelie Clurman
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emmanuel Dwomoh
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gabriel Armijo
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Antonio L C Gomes
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric R Littmann
- The Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Jonas Schluter
- Institute for Computational Medicine, New York University Langone Health, New York, NY, USA
| | - Emily Fontana
- Molecular Microbiology Core Facility, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying Taur
- Infectious Disease Service, Department of Medicine, and Immunology Program, Sloan Kettering Institute, New York, NY, USA
| | - Jae H Park
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Lia Palomba
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Halton
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Josel Ruiz
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tania Jain
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Martina Pennisi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Aishat Olaide Afuye
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Craig W Freyer
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Alfred Garfall
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
| | - Shannon Gier
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunita Nasta
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Landsburg
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - James Gerson
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jakub Svoboda
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Justin Cross
- The Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elise A Chong
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Saar I Gill
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Isabelle Riviere
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David L Porter
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Schuster
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Michel Sadelain
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Noelle Frey
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Renier J Brentjens
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carl H June
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Eric G Pamer
- The Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Jonathan U Peled
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Andrea Facciabene
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Ovarian Cancer Research Center, University of Pennsylvania, Philadelphia, PA, USA.
| | - Marcel R M van den Brink
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Immunology, Sloan Kettering Institute, New York, NY, USA.
| | - Marco Ruella
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
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8
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Scordo M, Flynn JR, Gonen M, Devlin SM, Parascondola A, Tomas AA, Shouval R, Brower J, Porter DL, Schuster SJ, Bachanova V, Maakaron J, Maziarz RT, Chen AI, Nastoupil LJ, McGuirk JP, Oluwole OO, Ip A, Leslie LA, Bishop MR, Riedell PA, Perales MA. Identifying an optimal fludarabine exposure for improved outcomes after axi-cel therapy for aggressive B-cell non-Hodgkin lymphoma. Blood Adv 2023; 7:5579-5585. [PMID: 37522731 PMCID: PMC10514205 DOI: 10.1182/bloodadvances.2023010302] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023] Open
Abstract
Fludarabine is one of the most common agents given for lymphodepletion before CD19 chimeric antigen receptor T cells, but its optimal therapeutic intensity is unknown. Using data from a multicenter consortium, we estimated fludarabine exposure (area under the curve [AUC]) using a population pharmacokinetic (PK) model in 199 adult patients with aggressive B-cell non-Hodgkin lymphomas who received commercial axicabtagene ciloleucel (Axi-cel). We evaluated the association of estimated fludarabine AUC with key outcomes, aiming to find an AUC that optimized efficacy and tolerability. We identified low (<18 mg × hour/L [mgh/L]), optimal (18-20 mgh/L), and high (>20 mgh/L) AUC groups for analyses; the 6-month cumulative incidences of relapse/progression of disease (relapse/POD) by AUC groups were 54% (45%-62%), 28% (15%-44%), and 30% (14%-47%), respectively; and the 1-year progression-free survival (PFS) rates were 39% (31%-48%), 66% (52%-84%), and 46% (30%-70%) and the overall survival (OS) rates were 58% (50%-67%), 77% (64%-92%), and 66% (50%-87%), respectively. In multivariable analyses compared with low AUC, an optimal AUC was associated with the highest PFS (hazard ratio [HR], 0.52; 0.3-0.91; P = .02) and lowest risk of relapse/POD (HR, 0.46; 0.25-0.84; P = .01) without an increased risk of any-grade cytokine release syndrome (HR, 1.1; 0.7-1.6; P = .8) or and immune effector cell-associated neurotoxicity syndrome (ICANS) (HR, 1.36; 0.83-2.3; P = .2). A high AUC was associated with the greatest risk of any-grade ICANS (HR, 1.9; 1.1-3.2; P = .02). Although the main cause of death in all groups was relapse/POD, nonrelapse-related deaths, including 3 deaths from ICANS, were more frequent in the high AUC group. These findings suggest that PK-directed fludarabine dosing to achieve an optimal AUC may result in improved outcomes for patients receiving axi-cel.
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Affiliation(s)
- Michael Scordo
- Adult Bone Marrow Transplant Service, Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Jessica R. Flynn
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gonen
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M. Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Roni Shouval
- Adult Bone Marrow Transplant Service, Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Jamie Brower
- Cell Therapy and Transplant and Lymphoma Programs, Division of Hematology-Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - David L. Porter
- Cell Therapy and Transplant and Lymphoma Programs, Division of Hematology-Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Stephen J. Schuster
- Cell Therapy and Transplant and Lymphoma Programs, Division of Hematology-Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation, Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Joseph Maakaron
- Division of Hematology, Oncology and Transplantation, Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Richard T. Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Andy I. Chen
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Loretta J. Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph P. McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Olalekan O. Oluwole
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew Ip
- Division of Lymphoma, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
- Department of Oncology, Hackensack Meridian School of Medicine, Nutley, NJ
| | - Lori A. Leslie
- Division of Lymphoma, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
- Department of Oncology, Hackensack Meridian School of Medicine, Nutley, NJ
| | - Michael R. Bishop
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Peter A. Riedell
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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9
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Lin RJ, Kim SJ, Brown S, Elko TA, Ruiz JD, Hanley DM, Lia Palomba M, Perales MA, Shah GL, Dahi PB, Scordo M, Sauter CS, Batlevi CL, Tomas AA, Shouval R, Lee N, Pavkovic EA, Engstler DE, Park JH, Salles GA, Devlin SM, Korc-Grodzicki B, Hamlin PA, Giralt SA. Prospective geriatric assessment and geriatric consultation in CAR T-cell therapy for older patients with lymphoma. Blood Adv 2023; 7:3501-3505. [PMID: 37078703 PMCID: PMC10362256 DOI: 10.1182/bloodadvances.2023010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Affiliation(s)
- Richard J. Lin
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Soo Jung Kim
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samantha Brown
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theresa A. Elko
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josel D. Ruiz
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle M. Hanley
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Lia Palomba
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Miguel-Angel Perales
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Gunjan L. Shah
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Parastoo B. Dahi
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Michael Scordo
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Craig S. Sauter
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Connie L. Batlevi
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ana Alarcon Tomas
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roni Shouval
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Nicole Lee
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emma A. Pavkovic
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle E. Engstler
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jae H. Park
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Gilles A. Salles
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M. Devlin
- Weill Cornell Medical College, New York, NY
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Beatriz Korc-Grodzicki
- Weill Cornell Medical College, New York, NY
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul A. Hamlin
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio A. Giralt
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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10
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Wudhikarn K, Tomas AA, Flynn JR, Devlin SM, Brower J, Bachanova V, Nastoupil LJ, McGuirk JP, Maziarz RT, Oluwole OO, Schuster SJ, Porter DL, Bishop MR, Riedell PA, Perales MA. Low toxicity and excellent outcomes in patients with DLBCL without residual lymphoma at the time of CD19 CAR T-cell therapy. Blood Adv 2023; 7:3192-3198. [PMID: 36355838 PMCID: PMC10338201 DOI: 10.1182/bloodadvances.2022008294] [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: 06/29/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022] Open
Abstract
CD19 chimeric antigen receptor (CAR) T-cell therapy represents a breakthrough for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL), inducing sustained remissions in these patients. However, CAR T cells can result in significant toxicities. Preinfusion disease burden is associated with toxicities and outcomes after CAR T-cell therapy. We identified 33 patients with R/R DLBCL treated at 8 academic centers who had no detectable disease at the time of CAR T-cell therapy. The median time from leukapheresis to CAR T-cell infusion was 48 (19-193) days. Nine patients received axicabtagene ciloleucel, and 24 received tisagenlecleucel. There was no severe (grade ≥3) cytokine release syndrome, and only 1 patient developed severe neurotoxicity (grade 4). After a median follow-up of 16 months, 13 patients relapsed (39.4%) and 6 died (18.1%). One-year event-free survival and overall survival were 59.6% and 81.3%, respectively. Our findings suggest that, in patients with R/R DLBCL who have an indication for CAR T-cell therapy, treating patients in complete remission at the time of infusion is feasible, safe, and associated with favorable disease control. Further exploration in a larger clinical trial setting is warranted.
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Affiliation(s)
- Kitsada Wudhikarn
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Division of Hematology and Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ana Alarcon Tomas
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Division of Hematology and Hemotherapy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jessica R. Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M. Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jamie Brower
- Blood and Marrow Transplant and Cellular Therapy Program, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Veronika Bachanova
- Division of Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Loretta J. Nastoupil
- Division of Cancer Medicine, Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph P. McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Medicine, The University of Kansas, Kansas City, KS
| | - Richard T. Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Olalekan O. Oluwole
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Stephen J. Schuster
- Blood and Marrow Transplant and Cellular Therapy Program, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - David L. Porter
- Blood and Marrow Transplant and Cellular Therapy Program, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Michael R. Bishop
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Peter A. Riedell
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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11
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Park JH, Nath K, Devlin SM, Sauter CS, Palomba ML, Shah G, Dahi P, Lin RJ, Scordo M, Perales MA, Shouval R, Tomas AA, Cathcart E, Mead E, Santomasso B, Holodny A, Brentjens RJ, Riviere I, Sadelain M. CD19 CAR T-cell therapy and prophylactic anakinra in relapsed or refractory lymphoma: phase 2 trial interim results. Nat Med 2023; 29:1710-1717. [PMID: 37400640 DOI: 10.1038/s41591-023-02404-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 02/26/2023] [Accepted: 05/17/2023] [Indexed: 07/05/2023]
Abstract
In preclinical models, anakinra, an IL-1 receptor antagonist (IL-1Ra), reduced immune effector cell-associated neurotoxicity syndrome (ICANS) without compromising anti-CD19 chimeric antigen receptor (CAR) T-cell efficacy. We initiated a phase 2 clinical trial of anakinra in patients with relapsed/refractory large B-cell lymphoma and mantle cell lymphoma treated with commercial anti-CD19 CAR T-cell therapy. Here we report a non-prespecified interim analysis reporting the final results from cohort 1 in which patients received subcutaneous anakinra from day 2 until at least day 10 post-CAR T-cell infusion. The primary endpoint was the rate of severe (grade ≥3) ICANS. Key secondary endpoints included the rates of all-grade cytokine release syndrome (CRS) and ICANS and overall disease response. Among 31 treated patients, 74% received axicabtagene ciloleucel, 13% received brexucabtagene ciloleucel and 4% received tisagenlecleucel. All-grade ICANS occurred in 19%, and severe ICANS occurred in 9.7% of patients. There were no grade 4 or 5 ICANS events. All-grade CRS occurred in 74%, and severe CRS occurred in 6.4% of patients. The overall disease response rate was 77% with 65% complete response rate. These initial results show that prophylactic anakinra resulted in a low incidence of ICANS in patients with lymphoma receiving anti-CD19 CAR T-cell therapy and support further study of anakinra in immune-related neurotoxicity syndromes.
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Affiliation(s)
- Jae H Park
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
- Department of Medicine, Weill Cornell Medicine, New York City, NY, USA.
| | - Karthik Nath
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Sean M Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Craig S Sauter
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Center for Cell Engineering, Sloan Kettering Institute, New York City, NY, USA
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - M Lia Palomba
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York City, NY, USA
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Gunjan Shah
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York City, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Parastoo Dahi
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York City, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Richard J Lin
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York City, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Michael Scordo
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York City, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Miguel-Angel Perales
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York City, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Roni Shouval
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York City, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Ana Alarcon Tomas
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Division of Hematology and Hemotherapy, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Elizabeth Cathcart
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Elena Mead
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Bianca Santomasso
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Andrei Holodny
- Radiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Renier J Brentjens
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Center for Cell Engineering, Sloan Kettering Institute, New York City, NY, USA
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Isabelle Riviere
- Center for Cell Engineering, Sloan Kettering Institute, New York City, NY, USA
- Michael G. Harris Cell Therapy and Cell Engineering Facility, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Michel Sadelain
- Center for Cell Engineering, Sloan Kettering Institute, New York City, NY, USA
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12
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Nguyen CL, Markey KA, Miltiadous O, Dai A, Waters N, Sadeghi K, Fei T, Shouval R, Taylor BP, Liao C, Slingerland JB, Slingerland AE, Clurman AG, Maloy MA, Bohannon L, Giardina PA, Brereton DG, Armijo GK, Fontana E, Gradissimo A, Gyurkocza B, Sung AD, Chao NJ, Devlin SM, Taur Y, Giralt SA, Perales MA, Xavier JB, Pamer EG, Peled JU, Gomes ALC, van den Brink MRM. High-resolution analyses of associations between medications, microbiome, and mortality in cancer patients. Cell 2023; 186:2705-2718.e17. [PMID: 37295406 PMCID: PMC10390075 DOI: 10.1016/j.cell.2023.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/12/2022] [Accepted: 05/05/2023] [Indexed: 06/12/2023]
Abstract
Discerning the effect of pharmacological exposures on intestinal bacterial communities in cancer patients is challenging. Here, we deconvoluted the relationship between drug exposures and changes in microbial composition by developing and applying a new computational method, PARADIGM (parameters associated with dynamics of gut microbiota), to a large set of longitudinal fecal microbiome profiles with detailed medication-administration records from patients undergoing allogeneic hematopoietic cell transplantation. We observed that several non-antibiotic drugs, including laxatives, antiemetics, and opioids, are associated with increased Enterococcus relative abundance and decreased alpha diversity. Shotgun metagenomic sequencing further demonstrated subspecies competition, leading to increased dominant-strain genetic convergence during allo-HCT that is significantly associated with antibiotic exposures. We integrated drug-microbiome associations to predict clinical outcomes in two validation cohorts on the basis of drug exposures alone, suggesting that this approach can generate biologically and clinically relevant insights into how pharmacological exposures can perturb or preserve microbiota composition. The application of a computational method called PARADIGM to a large dataset of cancer patients' longitudinal fecal specimens and detailed daily medication records reveals associations between drug exposures and the intestinal microbiota that recapitulate in vitro findings and are also predictive of clinical outcomes.
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Affiliation(s)
- Chi L Nguyen
- Gerstner Sloan Kettering Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kate A Markey
- 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
| | - Oriana Miltiadous
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Anqi Dai
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nicholas Waters
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Keimya Sadeghi
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Teng Fei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Roni Shouval
- 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
| | - Bradford P Taylor
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Chen Liao
- Program for Computational and Systems Biology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - John B Slingerland
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ann E Slingerland
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Annelie G Clurman
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Molly A Maloy
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Lauren Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Paul A Giardina
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Daniel G Brereton
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Gabriel K Armijo
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Emily Fontana
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ana Gradissimo
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Boglarka Gyurkocza
- 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
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ying Taur
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 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
| | - 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
| | - Joao B Xavier
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Eric G Pamer
- Duchossois Family Institute, University of Chicago, Chicago, IL 60637, USA
| | - Jonathan U Peled
- 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
| | - Antonio L C Gomes
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Marcel R M van den Brink
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; 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.
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13
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Bernard E, Ossa JEA, Tuechler H, Greenberg PL, Hasserjian RP, Nannya Y, Devlin SM, Creignou M, Pinel P, Monier L, Medina-Martinez JS, Domenico D, Jädersten M, Germing U, Sanz G, van de Loosdrecht AA, Kosmider O, Follo MY, Thol F, Zamora L, Pinheiro RF, Pellagatti A, Haase D, Fenaux P, Belickova M, Savona MR, Klimek VM, Santos FP, Boultwood J, Kotsianidis I, Santini V, Solé F, Platzbecker U, Heuser M, Valent P, Ohyashiki K, Finelli C, Voso MT, Shih LY, Fontenay M, Jansen JH, Cervera J, Gattermann N, Ebert BL, Bejar R, Malcovati L, Cazzola M, Ogawa S, Hellström-Lindberg E, Papaemmanuil E. Abstract 6168: Implementation and adoption of a web tool to support precision diagnostic and treatment decisions for patient with myelodysplastic syndromes. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-6168] [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: 04/07/2023]
Abstract
Abstract
Despite a detailed understanding of the genes mutated in myelodysplastic syndromes (MDS), diagnostic and treatment decisions for patients with MDS rely primarily on clinical and cytogenetic variables as considered by the Revised International Prognostic Scoring System (IPSS-R). Here we describe the recently developed Molecular IPSS (IPSS-M), a clinico-genomic risk stratification system that considers clinical, cytogenetic and genetic parameters; the implementation of a web portal to facilitate its adoption, a strategy to handle missing variables, and the worldwide utilization of the web calculator as a clinical support tool.
The IPSS-M was trained on 2,957 clinically annotated diagnostic MDS samples profiled for mutations in 156 driver genes. To maximize the clinical applicability of the IPSS-M and account for missing genetic data (i.e genes missing from a sequencing panel), we implemented a strategy to calculate a risk score under three scenarios: best, worst and average. Last, we developed an online calculator as a standalone single-page web application using VueJs, and D3Js for the interactive visualizations, deployed through a CI/CD pipeline on AWS, where collection of anonymous usage analytics allows to track adoption and usability of the new proposed model.
The model incorporates clinical, morphological, genetic variables informed by cytogenetics and constructed from the presence of oncogenic mutations in 31 genes. It delivers a unique risk score for each individual patient, as well as an assignment to one of six IPSS-M risk strata. Compared to the IPSS-R the IPSS-M re-stratified 46% of MDS patients. The model was validated in an external dataset of 754 MDS patients. We released an open-access IPSS-M web calculator available at https://mds-risk-model.com. By specifying the patient clinical and molecular profiles, the tool returns the patient-specific IPSS-M risk score and category, and the probability estimates over time for three clinical endpoints, i.e. leukemia free survival (LFS), overall survival, and incidence of leukemic transformation. Since its launch in June 2022, the calculator has been used by >6000 users in >75 countries, reaching a daily average of 100 users per day. Risks have been calculated for >45,000 patient profiles. 99.28% of the sessions initiated reach an IPSS-M score, suggesting that the calculator is intuitive and easy to use.
We trained and validated the IPSS-M on 3,711 patients, a patient tailored risk stratification tool for patients with MDS that considers clinical, morphological and genetic variables inclusive of cytogenetics and mutations in one of 31 genes. The development of a web based tool was instrumental to the global dissemination of the model, enabling non-expert users to leverage the power of molecular biomarkers in risk stratification for patients with MDS.
Citation Format: Elsa Bernard, Juan E. Arango Ossa, Heinz Tuechler, Peter L. Greenberg, Robert P. Hasserjian, Yasuhito Nannya, Sean M. Devlin, Maria Creignou, Philippe Pinel, Lily Monier, Juan S. Medina-Martinez, Dylan Domenico, Martin Jädersten, Ulrich Germing, Guillermo Sanz, Arjan A. van de Loosdrecht, Olivier Kosmider, Matilde Y. Follo, Felicitas Thol, Lurdes Zamora, Ronald F. Pinheiro, Andrea Pellagatti, Detlef Haase, Pierre Fenaux, Monika Belickova, Michael R. Savona, Virginia M. Klimek, Fabio P. Santos, Jacqueline Boultwood, Ioannis Kotsianidis, Valeria Santini, Francesc Solé, Uwe Platzbecker, Michael Heuser, Peter Valent, Kazuma Ohyashiki, Carlo Finelli, Maria Teresa Voso, Lee-Yung Shih, Michaela Fontenay, Joop H. Jansen, José Cervera, Norbert Gattermann, Benjamin L. Ebert, Rafael Bejar, Luca Malcovati, Mario Cazzola, Seishi Ogawa, Eva Hellström-Lindberg, Elli Papaemmanuil. Implementation and adoption of a web tool to support precision diagnostic and treatment decisions for patient with myelodysplastic syndromes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6168.
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Affiliation(s)
- Elsa Bernard
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Heinz Tuechler
- 2Institute of Science and Technology Austria, Klosterneuburg, Austria
| | | | | | | | | | - Maria Creignou
- 6Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Lily Monier
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Martin Jädersten
- 6Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Guillermo Sanz
- 8Hospital Universitario y Politécnico La Fe, Valencia, Spain and CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Olivier Kosmider
- 10Assistance Publique-Hôpitaux de Paris, Hôpital Cochin and Université de Paris, Université Paris Descartes, Paris, France
| | | | | | - Lurdes Zamora
- 13Hospital Germans Trias i Pujol, Institut Català d’Oncologia, Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Ronald F. Pinheiro
- 14Drug Research and Development Center, Federal University of Ceara, Ceara, Brazil
| | - Andrea Pellagatti
- 15University of Oxford and Oxford BRC Haematology Theme, Oxford, United Kingdom
| | - Detlef Haase
- 16INDIGHO Laboratories. Clinics of Hematology and Medical Oncology, University Medical Center, Göttingen, Germany
| | | | - Monika Belickova
- 18Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Michael R. Savona
- 19Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | | | | | | | | | - Valeria Santini
- 22Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesc Solé
- 23Institut de Recerca contra la Leucèmia Josep Carreras, Barcelona, Spain
| | | | | | - Peter Valent
- 25Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Carlo Finelli
- 27Institute of Hematology “Seràgnoli”, Istituti di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Lee-Yung Shih
- 29Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Michaela Fontenay
- 10Assistance Publique-Hôpitaux de Paris, Hôpital Cochin and Université de Paris, Université Paris Descartes, Paris, France
| | - Joop H. Jansen
- 30Radboud University Medical Centre, Nijmegen, Netherlands
| | | | | | | | - Rafael Bejar
- 33University of California San Diego Moores Cancer Center, La Jolla, CA
| | | | | | - Seishi Ogawa
- 35Institute for the Advanced Study of Human Biology, Kyoto University, Kyoto, Japan
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14
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Eng SW, Vadakkel G, Fingrut WB, Murillo S, Brown S, Devlin SM, Cook M, DeRespiris L, Gutierrez J, Lin A, Monaco S, Nauffal M, Giralt SA, Perales MA, Barker JN, Cho C, Shah G. Insurance Barriers to High-Cost Anti-Infective Medications Post Allogeneic Hematopoietic Cell Transplant. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Devlin SM, O'Quigley J. Deconstructing the Kaplan-Meier curve: Quantification of treatment effect using the treatment effect process. Contemp Clin Trials 2023; 125:107043. [PMID: 36473681 PMCID: PMC9918692 DOI: 10.1016/j.cct.2022.107043] [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: 10/02/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
In studies of survival and its association with treatment and other prognostic variables, elapsed time alone will often show itself to be among the strongest, if not the strongest, of the predictor variables. Kaplan-Meier curves will show the overall survival of each group and the general differences between groups due to treatment. However, the time-dependent nature of treatment effects is not always immediately transparent from these curves. More sophisticated tools are needed to spotlight the treatment effects. An important tool in this context is the treatment effect process. This tool can be potent in revealing the complex myriad of ways in which treatment can affect survival time. We look at a recently published study in which the outcome was relapse-free survival, and we illustrate how the use of the treatment effect process can provide a much deeper understanding of the relationship between time and treatment in this trial.
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Affiliation(s)
- Sean M Devlin
- Memorial Sloan Kettering Cancer Center, New York, USA.
| | - John O'Quigley
- Department of Statistical Science, University College London, UK.
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16
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Walji DM, Lee J, Devlin SM, Gany FM, Giralt S, Perales MA, Cho C. Association of Linguistic Barriers and Survival in Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00532-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Fried S, Shouval R, Walji M, Flynn JR, Yerushalmi R, Shem-Tov N, Danylesko I, Tomas AA, Fein JA, Devlin SM, Sauter CS, Shah GL, Kedmi M, Jacoby E, Shargian L, Raanani P, Yeshurun M, Perales MA, Nagler A, Avigdor A, Shimoni A. Allogeneic Hematopoietic Cell Transplantation after Chimeric Antigen Receptor T Cell Therapy in Large B Cell Lymphoma. Transplant Cell Ther 2023; 29:99-107. [PMID: 36343892 PMCID: PMC10387120 DOI: 10.1016/j.jtct.2022.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/20/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Anti-CD19 chimeric antigen receptor T cell (CAR-T) therapy has transformed the care of patients with relapsed/refractory large B cell lymphoma (LBCL). However, approximately 60% of CAR-T recipients ultimately will experience disease recurrence or progression. Salvage therapies after CAR-T treatment failures are of limited efficacy and have a short duration of response. The objective of the present study was to evaluate the role of allogeneic hematopoietic cell transplantation (allo-HCT) after CAR-T therapy in LBCL patients. This was a multicenter observational study reporting the outcome of 39 adult LBCL patients who underwent allo-HCT following anti-CD19 CAR-T therapy. The median patient age was 47 years (range, 20 to 68 years). HLA-matched sibling, HLA-matched unrelated, and alternative donors were used in 36%, 36%, and 28% of transplantations, respectively. Conditioning regimens were primarily of low or intermediate intensity. Disease status at allo-HCT was complete response in 41%, partial response in 38%, and progressive disease in 21%. Allo-HCT was performed at a median of 127 days (range, 82 to 206 days) after CAR-T therapy. A high incidence of hepatic toxicity (28%), including sinusoidal obstruction syndrome (15.4%; 95% confidence interval; [CI], 6.2% to 28.5%), was observed. The 1-year cumulative incidence of grade II-IV and grade III-IV acute graft-versus-host disease (GVHD) was 38.5% (95% CI, 23.2% to 53.6%) and 15.4% (95% CI, 6.1% to 28.5%), respectively. The 2-year cumulative incidence of moderate-severe chronic GVHD was 11.1% (95% CI, 3.3% to 24.3%). Overall, 2-year nonrelapse mortality and relapse/progression incidence were 26% (95% CI, 13% to 41%) and 43% (95% CI, 27% to 59%), respectively. With a median follow-up of 32 months, the 2-year overall survival (OS) and progression-free survival (PFS) were 45% (95% CI, 31% to 66%) and 31% (95% CI, 19% to 50%), respectively. In multivariable analyses, pre-HCT elevated lactate dehydrogenase level and transformed lymphoma were predictive of OS and PFS, respectively. Our data suggest that allo-HCT after anti-CD19 CAR-T treatment failure is feasible with a relatively promising efficacy but possibly high toxicity rate.
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Affiliation(s)
- Shalev Fried
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Roni Shouval
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Moneeza Walji
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica R Flynn
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ronit Yerushalmi
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Noga Shem-Tov
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ivetta Danylesko
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ana Alarcon Tomas
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; PhD Program in Signals Integration and Modulation in Biomedicine, Cellular Therapy, and Translational Medicine, University of Murcia, Murcia, Spain
| | - Joshua A Fein
- University of Connecticut Medical Center, Farmington, Connecticut
| | - Sean M Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Craig S Sauter
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Gunjan L Shah
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Meirav Kedmi
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel; The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat Gan, Israel
| | - Elad Jacoby
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Pediatric Hematology-Oncology, Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Liat Shargian
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel; Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel
| | - Pia Raanani
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel; Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel
| | - Moshe Yeshurun
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel; Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Abraham Avigdor
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Avichai Shimoni
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Tamari R, Scordo M, Flyn J, Devlin SM, Klein E, Cancio MI, Curran KJ, Jakubowski A, Kernan NA, Papadopoulos EB, Scaradavou A, Shaffer BC, Shah G, Spitzer B, Gyurkocza B, Giralt SA, Perales MA, Boelens JJ. Busulfan Exposure Is Associated with Survival in Pediatric and Adult AML/MDS Patients Undergoing a CD34+ Selected Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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Corona M, Shouval R, Alarcón A, Flynn J, Devlin SM, Batlevi CW, Fein DJA, Giralt S, Lynn R, Nath K, Palomba ML, Parascondola A, Shah GL, Salles G, Scordo M, Walji DM, Perales MA, Dahi PB. Severe Persistent Cytopenias Following CAR T-Cell Therapy in Patients with Large B-Cell Lymphoma. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Dahi PB, Shahrokni A, Flynn J, Devlin SM, Chinapen MS, Ayala J, Brown S, Bugen S, Cho C, Gyurkocza B, Lin DRJ, Papadopoulos EB, Perales MA, Politikos I, Ponce DM, Shaffer BC, Shah GL, Tamari R, Young JW, Giralt SA, Jakubowski AA. Geriatric Assessment and Outcomes of Allogeneic Hematopoietic Cell Transplantation in Older Patients. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00638-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Elias S, Brown S, Devlin SM, Barker JN, Cho C, Chung DJ, Dahi PB, Giralt SA, Gyurkocza B, Jakubowski A, Lahoud OB, Landau HJ, Lin DRJ, Papadopoulos EB, Politikos I, Ponce DM, Scordo M, Shaffer BC, Shah GL, Tamari R, Young JW, Perales MA, Shouval R. The Simplified Comorbidity Index Predicts Non-Relapse Mortality in Patients Receiving Allogeneic Hematopoietic Stem Cell Transplant after Reduced-Intensity Conditioning. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Elias S, Walji DM, Brown S, Devlin SM, Papadopoulos EB, Jakubowski AA, Ponce DM, Young JW, Giralt SA, Perales MA, Shaffer BC, Dahi PB, Lin DRJ, Cho C, Tamari R, Smith M, Gyurkocza B. Allogeneic Hematopoietic Cell Transplantation in Patients with Relapsed or Refractory Acute Leukemia. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Shouval R, Waters NR, Gomes ALC, Zuanelli Brambilla C, Fei T, Devlin SM, Nguyen CL, Markey KA, Dai A, Slingerland JB, Clurman AG, Fontana E, Amoretti LA, Wright RJ, Hohl TM, Taur Y, Sung AD, Weber D, Hashimoto D, Teshima T, Chao NJ, Holler E, Scordo M, Giralt SA, Perales MA, Peled JU, van den Brink MRM. Conditioning Regimens are Associated with Distinct Patterns of Microbiota Injury in Allogeneic Hematopoietic Cell Transplantation. Clin Cancer Res 2023; 29:165-173. [PMID: 36322005 PMCID: PMC9812902 DOI: 10.1158/1078-0432.ccr-22-1254] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/13/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE The gut microbiota is subject to multiple insults in allogeneic hematopoietic cell transplantation (allo-HCT) recipients. We hypothesized that preparative conditioning regimens contribute to microbiota perturbation in allo-HCT. EXPERIMENTAL DESIGN This was a retrospective study that evaluated the relationship between conditioning regimens exposure in 1,188 allo-HCT recipients and the gut microbiome. Stool samples collected from 20 days before transplantation up to 30 days after were profiled using 16S rRNA sequencing. Microbiota injury was quantified by changes in α-diversity. RESULTS We identified distinct patterns of microbiota injury that varied by conditioning regimen. Diversity loss was graded into three levels of conditioning-associated microbiota injury (CMBI) in a multivariable model that included antibiotic exposures. High-intensity regimens, such as total body irradiation (TBI)-thiotepa-cyclophosphamide, were associated with the greatest injury (CMBI III). In contrast, the nonmyeloablative regimen fludarabine-cyclophosphamide with low-dose TBI (Flu/Cy/TBI200) had a low-grade injury (CMBI I). The risk of acute GVHD correlated with CMBI degree. Pretransplant microbial compositions were best preserved with Flu/Cy/TBI200, whereas other regimens were associated with loss of commensal bacteria and expansion of Enterococcus. CONCLUSIONS Our findings support an interaction between conditioning at the regimen level and the extent of microbiota injury.
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Affiliation(s)
- Roni Shouval
- 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
| | - Nicholas R Waters
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Antonio L C Gomes
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Corrado Zuanelli Brambilla
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medical Biotechnologies, University of Siena, Siena, Italy.,Hematology Unit, Department of Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Teng Fei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chi L Nguyen
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kate A Markey
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anqi Dai
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John B Slingerland
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Annelie G Clurman
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily Fontana
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luigi A Amoretti
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roberta J Wright
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tobias M Hohl
- 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
| | - Ying Taur
- 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
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Daniela Weber
- Department of Internal Medicine, University Medical Center, University of Regensburg, Regensburg, Germany
| | - Daigo Hashimoto
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Ernst Holler
- Department of Internal Medicine, University Medical Center, University of Regensburg, Regensburg, Germany
| | - Michael Scordo
- 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
| | - Sergio A 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
| | - Miguel-Angel Perales
- 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
| | - Jonathan U Peled
- 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
| | - Marcel R M van den Brink
- 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.,Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
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24
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Burgos da Silva M, Ponce DM, Dai A, M. Devlin S, Gomes ALC, Moore G, Slingerland J, Shouval R, Armijo GK, DeWolf S, Fei T, Clurman A, Fontana E, Amoretti LA, Wright RJ, Andrlova H, Miltiadous O, Perales MA, Taur Y, Peled JU, van den Brink MRM. Preservation of the fecal microbiome is associated with reduced severity of graft-versus-host disease. Blood 2022; 140:2385-2397. [PMID: 35969834 PMCID: PMC9837450 DOI: 10.1182/blood.2021015352] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 12/31/2021] [Accepted: 06/12/2022] [Indexed: 01/21/2023] Open
Abstract
Following allogeneic hematopoietic cell transplantation (allo-HCT), the gastrointestinal (GI) tract is frequently affected by acute graft-versus-host disease (aGVHD), the pathophysiology of which is associated with a dysbiotic microbiome. Since microbial composition varies along the length of the GI tract, the authors hypothesized that microbiome features correlate with the pattern of organ involvement after allo-HCT. We evaluated 266 allo-HCT recipients from whom 1303 stool samples were profiled by 16S ribosomal gene sequencing. Patients were classified according to which organs were affected by aGVHD. In the 20 days prior to disease onset, GVHD patients had lower abundances of members of the class Clostridia, lower counts of butyrate producers, and lower ratios of strict-to-facultative (S/F) anaerobic bacteria compared with allograft recipients who were free of GVHD. GI GVHD patients showed significant reduction in microbial diversity preonset. Patients with lower GI aGVHD had lower S/F anaerobe ratios compared with those with isolated upper GI aGVHD. In the 20 days after disease onset, dysbiosis was observed only in GVHD patients with GI involvement, particularly those with lower-tract disease. Importantly, Clostridial and butyrate-producer abundance as well as S/F anaerobe ratio were predictors of longer overall survival; higher abundance of butyrate producers and higher S/F anaerobe ratio were associated with decreased risk of GVHD-related death. These findings suggest that the intestinal microbiome can serve as a biomarker for outcomes of allo-HCT patients with GVHD.
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Affiliation(s)
| | - Doris M. Ponce
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Anqi Dai
- Department of Immunology, Sloan Kettering Institute, New York, NY
| | - Sean M. Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY
| | | | - Gillian Moore
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - John Slingerland
- Department of Immunology, Sloan Kettering Institute, New York, NY
| | - Roni Shouval
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Susan DeWolf
- Leukemia Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - Teng Fei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY
| | - Annelie Clurman
- Department of Immunology, Sloan Kettering Institute, New York, NY
| | - Emily Fontana
- Department of Immunology, Sloan Kettering Institute, New York, NY
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - Luigi A. Amoretti
- Department of Immunology, Sloan Kettering Institute, New York, NY
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - Roberta J. Wright
- Department of Immunology, Sloan Kettering Institute, New York, NY
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - Hana Andrlova
- Department of Immunology, Sloan Kettering Institute, New York, NY
| | | | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ying Taur
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - Jonathan U. Peled
- Department of Immunology, Sloan Kettering Institute, New York, NY
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Marcel R. M. van den Brink
- Department of Immunology, Sloan Kettering Institute, New York, NY
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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25
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Landau HJ, Orlando E, Rodriguez ES, Applebaum A, Mitchell HR, Peled JU, Khan N, Funnell T, Chung D, Scordo M, Shah GL, LeStrange NJ, Hambright KA, McElrath CM, Cazeau N, Devlin SM, Perales MA, Giralt SA. Pilot Trial of Homebound Hematopoietic Cell Transplantation. Transplant Cell Ther 2022; 28:832.e1-832.e7. [PMID: 36182105 PMCID: PMC9888402 DOI: 10.1016/j.jtct.2022.09.014] [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: 05/17/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
For eligible patients with multiple myeloma (MM) and amyloid light chain (AL) amyloidosis, high-dose chemotherapy and autologous hematopoietic cell transplantation (HCT) is a standard and widely used consolidation therapy. Autologous HCT requires specialized care at a transplantation center and investment from patients and caregivers. We studied the safety and feasibility of delivering transplantation care in a homebound setting to decrease the burden of therapy and increase access to autologous HCT. Patients with MM and AL amyloidosis undergoing autologous HCT were eligible if they resided in designated ZIP codes and had a full-time caregiver, Wi-Fi connection, HCT Comorbidity Index ≤3, and Karnofsky Performance Status score ≥80. High-dose melphalan (on day -2) and hematopoietic cell reinfusion (day 0) were administered in the outpatient clinic. Protocol-specific home care was provided from day +1 through engraftment. Patients were assessed and blood was drawn daily by advanced practice providers. Interventions were delivered by registered nurses. Attending physicians communicated daily through telemedicine. Quality of life, patient and caregiver satisfaction, and fecal microbiota profiling data were collected. Fifteen patients were enrolled and received transplantation care at home starting on day +1 following hematopoietic cell infusion. Patients remained in the program for an average of 12 days and required an average of 2 outpatient visits while receiving home care. Seven of 15 patients were admitted for a median of 4 days (range, 3 to 10 days); admission occurred on day +7 in 5 patients, on day +8 in 1 patient, and on day +12 in 1 patient for neutropenic fever in 2 patients, fever attributed to engraftment syndrome in 2 patients, diarrhea in 2 patients, and dehydration in 1 patient. Only 1 patient had a documented infection (Clostridioides difficile). One patient admitted with neutropenic fever required intensive care unit admission for a gastrointestinal bleed. Forty-seven percent of the patients experienced a grade ≥3 nonhematologic toxicity. There were no deaths on the study. Patients and caregivers reported high satisfaction with care. Microbiota diversity patterns were similar to those of autologous HCT recipients who did not receive post-HCT care at home, although a subset of the cohort maintained microbiota diversity throughout. Homebound HCT in an urban setting is safe and feasible, with less than one-half of patients requiring inpatient admission. Despite increased patient and caregiver responsibility in the homebound setting compared with an inpatient setting, patient and caregiver satisfaction was high. These results support expansion of homebound transplantation care programs.
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Affiliation(s)
- Heather J Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Evelyn Orlando
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | | | - Allison Applebaum
- Counseling Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hannah-Rose Mitchell
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan U Peled
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Niloufer Khan
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tyler Funnell
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nicole J LeStrange
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katie A Hambright
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Courtney M McElrath
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naomi Cazeau
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, 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
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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26
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Nawas MT, Sanchez-Escamilla M, Devlin SM, Maloy MA, Ruiz JD, Sauter CS, Giralt SA, Perales MA, Scordo M. Dynamic EASIX scores closely predict nonrelapse mortality after allogeneic hematopoietic cell transplantation. Blood Adv 2022; 6:5898-5907. [PMID: 35977079 PMCID: PMC9661383 DOI: 10.1182/bloodadvances.2022007381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Abstract
Endothelial activation and stress index (EASIX) predicts nonrelapse mortality (NRM) when assessed before hematopoietic cell transplantation (HCT). We sought to determine whether changes in EASIX after HCT may be an informative marker of NRM. We evaluated 509 adults who underwent reduced intensity, unmodified (N = 149, 29%), or myeloablative ex vivo CD34+-selected allogeneic HCT (allo-HCT) (N = 306, 71%) between 2008 and 2016. Patients who underwent unmodified allo-HCT received tacrolimus-based graft-versus-host disease (GVHD) prophylaxis, whereas CD34+-selected patients received no planned immunosuppression. EASIX (lactate dehydrogenase × creatinine/platelet count) was calculated continuously until 1-year after HCT. Log transformation using base 2 (log2) was applied to all EASIX variables to reduce skew. In total, 360 patients (71%) received CD34+-selected and 149 (29%) unmodified allo-HCT. Among all patients, EASIX scores increased rapidly, peaked at day +8, then declined rapidly until day +33. Thereafter, scores declined gradually but remained above the pre-HCT baseline. In unmodified HCT, scores appeared higher over time than in CD34+-selected patients. EASIX discrimination of NRM was highest around day +180 (concordance index = 0.85) in both platforms, but the prognostic impact of EASIX across time points differed between the 2 platforms. Mean EASIX scores were higher in men (mean log2 +0.52) and in patients who developed grade 2 to 4 GVHD (+0.81) and lower in patients who received matched vs mismatched donors (-0.81, all P < .01). EASIX scores are dynamic and variably concordant with NRM when analyzed longitudinally, and patterns differ between HCT platforms. Compared to pre-HCT evaluation, post-HCT EASIX scores may better predict risk of NRM as patients acquire additional endothelial injury and toxicities.
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Affiliation(s)
- Mariam T. Nawas
- Hematopoietic Cellular Therapy Program, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Miriam Sanchez-Escamilla
- Department of Hematological Malignancies and Stem Cell Transplantation, Research Institute of Marques de Valdecilla (IDIVAL), Santander, Spain
| | - Sean M. Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Molly A. Maloy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josel D. Ruiz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Craig S. 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
| | - Sergio A. 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
| | - Miguel-Angel 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
| | - Michael Scordo
- 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
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27
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Scordo M, Shah GL, Adintori PA, Knezevic A, Devlin SM, Buchan ML, Preston EV, Lin AP, Rodriguez NT, Carino CA, Nguyen LK, Sitner NC, Barasch A, Klang MG, Maloy MA, Mastrogiacomo B, Carlow DC, Schofield RC, Slingerland AE, Slingerland JB, Stein-Thoeringer CK, Lahoud OB, Landau HJ, Chung DJ, van den Brink MRM, Peled JU, Giralt SA. A prospective study of dysgeusia and related symptoms in patients with multiple myeloma after autologous hematopoietic cell transplantation. Cancer 2022; 128:3850-3859. [PMID: 36041227 PMCID: PMC10010839 DOI: 10.1002/cncr.34444] [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: 03/18/2022] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Dysgeusia is a common but understudied complication in patients undergoing autologous hematopoietic cell transplantation (auto-HCT). We assessed the feasibility of using chemical gustometry (CG) to measure dysgeusia and explored its associations with symptom burden, nutrition, chemotherapy pharmacokinetics (PK), and the oral microbiome. METHODS We conducted a single-center, prospective feasibility study (NCT03276481) of patients with multiple myeloma undergoing auto-HCT. CG was performed longitudinally testing five flavors (sweet, sour, salty, bitter, umami) to calculate a total taste score (maximum score, 30). We measured caloric intake and patient-reported symptoms, assessing their correlation with oral microbiota composition and salivary and blood melphalan PK exposure. RESULTS Among all 45 patients, 39 (87%) completed at least four (>60%) and 22 (49%) completed all six CG assessments. Median total CG scores remained stable over time but were lowest at day +7 (27, range 24-30) with recovery by day +100. Symptom burden was highest by day +10 (area under the curve, 2.9; range, 1.0-4.6) corresponding with the lowest median overall caloric intake (1624 kcal; range, 1345-2267). Higher serum/salivary melphalan levels correlated with higher patient-reported dysgeusia and lower caloric intake. Oral microbiota α-diversity was stable early and increased slightly by day +100. CONCLUSIONS Assessment of dysgeusia by CG is feasible after auto-HCT. Most dysgeusia, symptom burden, and lowest caloric intake occurred during the blood count nadir. Higher melphalan concentrations correlated with more dysgeusia and poorer caloric intake. Future studies will aim to modulate melphalan exposure by PK-targeted dosing and characterize patient taste preferences to personalize diets for improved nutritional intake. LAY SUMMARY Taste changes after cancer treatments are very common. We used chemical gustometry (taste testing) to study taste changes and to better understand why patients with multiple myeloma experience this symptom after autologous hematopoietic cell transplantation. We found that taste testing was feasible, taste changes peaked when blood counts were lowest, and most patients recovered their taste by 100 days after transplantation. Taste changes correlated with lower food intake and with higher levels of chemotherapy in the body. Future work will focus on using personalized chemotherapy doses to reduce taste changes and to match patients' individual taste preferences with their diets.
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Affiliation(s)
- Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Peter A Adintori
- Food and Nutrition Services, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrea Knezevic
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sean M Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Elaina V Preston
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew P Lin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Natasia T Rodriguez
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Caroline A Carino
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Linh K Nguyen
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nancy Cruz Sitner
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrei Barasch
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Mark G Klang
- Research Pharmacy, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Molly A Maloy
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brooke Mastrogiacomo
- Human Oncology and Pathogenesis Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dean C Carlow
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ryan C Schofield
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ann E Slingerland
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John B Slingerland
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Oscar B Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Heather J Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Marcel R M van den Brink
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jonathan U Peled
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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Mailankody S, Devlin SM, Landa J, Nath K, Diamonte C, Carstens EJ, Russo D, Auclair R, Fitzgerald L, Cadzin B, Wang X, Sikder D, Senechal B, Bermudez VP, Purdon TJ, Hosszu K, McAvoy DP, Farzana T, Mead E, Wilcox JA, Santomasso BD, Shah GL, Shah UA, Korde N, Lesokhin A, Tan CR, Hultcrantz M, Hassoun H, Roshal M, Sen F, Dogan A, Landgren O, Giralt SA, Park JH, Usmani SZ, Rivière I, Brentjens RJ, Smith EL. GPRC5D-Targeted CAR T Cells for Myeloma. N Engl J Med 2022; 387:1196-1206. [PMID: 36170501 DOI: 10.1056/nejmoa2209900] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T-cell therapies have generated responses in patients with advanced myeloma, but relapses are common. G protein-coupled receptor, class C, group 5, member D (GPRC5D) has been identified as an immunotherapeutic target in multiple myeloma. Preclinical studies have shown the efficacy of GPRC5D-targeted CAR T cells, including activity in a BCMA antigen escape model. METHODS In this phase 1 dose-escalation study, we administered a GPRC5D-targeted CAR T-cell therapy (MCARH109) at four dose levels to patients with heavily pretreated multiple myeloma, including patients with relapse after BCMA CAR T-cell therapy. RESULTS A total of 17 patients were enrolled and received MCARH109 therapy. The maximum tolerated dose was identified at 150×106 CAR T cells. At the 450×106 CAR T-cell dose, 1 patient had grade 4 cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS), and 2 patients had a grade 3 cerebellar disorder of unclear cause. No cerebellar disorder, ICANS of any grade, or cytokine release syndrome of grade 3 or higher occurred in the 12 patients who received doses of 25×106 to 150×106 cells. A response was reported in 71% of the patients in the entire cohort and in 58% of those who received doses of 25×106 to 150×106 cells. The patients who had a response included those who had received previous BCMA therapies; responses were observed in 7 of 10 such patients in the entire cohort and in 3 of 6 such patients who received 25×106 to 150×106 cells. CONCLUSIONS The results of this study of a GPRC5D-targeted CAR T-cell therapy (MCARH109) confirm that GPRC5D is an active immunotherapeutic target in multiple myeloma. (Funded by Juno Therapeutics/Bristol Myers Squibb; ClinicalTrials.gov number, NCT04555551.).
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Affiliation(s)
- Sham Mailankody
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Sean M Devlin
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Jonathan Landa
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Karthik Nath
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Claudia Diamonte
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Elizabeth J Carstens
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Douglas Russo
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Romany Auclair
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Lisa Fitzgerald
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Briana Cadzin
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Xiuyan Wang
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Devanjan Sikder
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Brigitte Senechal
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Vladimir P Bermudez
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Terence J Purdon
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Kinga Hosszu
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Devin P McAvoy
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Tasmin Farzana
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Elena Mead
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Jessica A Wilcox
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Bianca D Santomasso
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Gunjan L Shah
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Urvi A Shah
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Neha Korde
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Alexander Lesokhin
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Carlyn R Tan
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Malin Hultcrantz
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Hani Hassoun
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Mikhail Roshal
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Filiz Sen
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Ahmet Dogan
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Ola Landgren
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Sergio A Giralt
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Jae H Park
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Saad Z Usmani
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Isabelle Rivière
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Renier J Brentjens
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Eric L Smith
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
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Tazi Y, Arango-Ossa JE, Zhou Y, Bernard E, Thomas I, Gilkes A, Freeman S, Pradat Y, Johnson SJ, Hills R, Dillon R, Levine MF, Leongamornlert D, Butler A, Ganser A, Bullinger L, Döhner K, Ottmann O, Adams R, Döhner H, Campbell PJ, Burnett AK, Dennis M, Russell NH, Devlin SM, Huntly BJP, Papaemmanuil E. Unified classification and risk-stratification in Acute Myeloid Leukemia. Nat Commun 2022; 13:4622. [PMID: 35941135 PMCID: PMC9360033 DOI: 10.1038/s41467-022-32103-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/11/2022] [Indexed: 02/02/2023] Open
Abstract
Clinical recommendations for Acute Myeloid Leukemia (AML) classification and risk-stratification remain heavily reliant on cytogenetic findings at diagnosis, which are present in <50% of patients. Using comprehensive molecular profiling data from 3,653 patients we characterize and validate 16 molecular classes describing 100% of AML patients. Each class represents diverse biological AML subgroups, and is associated with distinct clinical presentation, likelihood of response to induction chemotherapy, risk of relapse and death over time. Secondary AML-2, emerges as the second largest class (24%), associates with high-risk disease, poor prognosis irrespective of flow Minimal Residual Disease (MRD) negativity, and derives significant benefit from transplantation. Guided by class membership we derive a 3-tier risk-stratification score that re-stratifies 26% of patients as compared to standard of care. This results in a unified framework for disease classification and risk-stratification in AML that relies on information from cytogenetics and 32 genes. Last, we develop an open-access patient-tailored clinical decision support tool.
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Grants
- MC_PC_17230 Medical Research Council
- BRC-1215-20014 Department of Health
- 203151/Z/16/Z Wellcome Trust
- MR-R009708-1 Medical Research Council
- C18680/A25508 Cancer Research UK
- 29806 Cancer Research UK
- 25350 Cancer Research UK
- P30 CA008748 NCI NIH HHS
- 25508 Cancer Research UK
- 25643 Cancer Research UK
- MR/R009708/1 Medical Research Council
- C49940/A25117 Cancer Research UK
- 205254/Z/16/Z Wellcome Trust
- E.P. is a Josie Robertson Investigator and is supported by the European Hematology Association, American Society of Hematology, Gabrielle’s Angels Foundation, V Foundation and The Geoffrey Beene Foundation and is a Damon Runyon Rachleff Innovator fellow. Work in the BJPH lab is funded by Cancer Research UK (C18680/A25508), the European Research Council (647685), MRC (MR-R009708-1), the Kay Kendall Leukaemia Fund (KKL1243), the Wellcome Trust (205254/Z/16/Z) and the Cancer Research UK Cambridge Major Centre (C49940/A25117). This research was supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014), and was funded in part, by the Wellcome Trust who supported the Wellcome - MRC Cambridge Stem Cell Institute (203151/Z/16/Z). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. L.B., H.D. and B.J.P.H. are supported by the HARMONY Alliance (IMI Project No. 116026; https://www.harmony-alliance.eu/). The UK-NCRI AML working group trials were supported with research grants from the Medical Research Council (MRC), Cancer Research UK (CRUK), Blood Cancer UK and Cardiff University. We would like to thank all patients and investigators for their participation in the trials and the study.
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Affiliation(s)
- Yanis Tazi
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Tri-Institutional Computational Biology and Medicine PhD Program, Weill Cornell Medicine of Cornell University and Rockefeller University, New York, NY, USA
- The Rockefeller University, New York, NY, USA
| | - Juan E Arango-Ossa
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yangyu Zhou
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elsa Bernard
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Thomas
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Amanda Gilkes
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Yoann Pradat
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean J Johnson
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Robert Hills
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, UK
| | - Max F Levine
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Leongamornlert
- Cancer, Ageing and Somatic Mutation Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Adam Butler
- Cancer, Ageing and Somatic Mutation Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology, and Tumorimmunology, Campus Virchow Klinikum, Berlin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Oliver Ottmann
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - Richard Adams
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Hartmut Döhner
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Peter J Campbell
- Cancer, Ageing and Somatic Mutation Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Alan K Burnett
- Visiting Professor University of Glasgow, formerly Cardiff University, Cardiff, UK
| | | | - Nigel H Russell
- Department of Haematology, Nottingham University Hospital, Nottingham, UK
| | - Sean M Devlin
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian J P Huntly
- Department of Haematology and Wellcome Trust-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Elli Papaemmanuil
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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30
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Dahi PB, Lin A, Scordo M, Flynn JR, Devlin SM, Ruiz JD, DeRespiris L, Carlow D, Cho C, Lahoud OB, Perales MA, Sauter CS, Boelens JJ, Admiraal R, Giralt SA, Shah GL. Evaluation of Melphalan Exposure in Lymphoma Patients Undergoing BEAM and Autologous Hematopoietic Cell Transplantation. Transplant Cell Ther 2022; 28:485.e1-485.e6. [PMID: 35545213 PMCID: PMC9357179 DOI: 10.1016/j.jtct.2022.05.003] [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: 03/17/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022]
Abstract
High-dose melphalan is one of the main cytotoxic DNA alkylating agents and is used in many transplantation conditioning regimens. Studies have shown a wide range of drug exposure when a traditional weight-based dose of melphalan is used. The optimal melphalan dose in BEAM (carmustine, etoposide, cytarabine, and melphalan), which results in maximum efficacy with acceptable toxicity, is unknown. In this pharmacokinetic (PK) analysis of 105 patients with lymphoma undergoing treatment with BEAM and autologous hematopoietic cell transplantation, we initially estimated melphalan exposure as area under the curve (AUC) by a noncompartmental analysis and subsequently compared it with a newly developed 2-compartment population-PK model. The 2 models correlated closely with each other. We found that the traditional fixed weight-based dosing of propylene glycol-free (captisol-enabled) melphalan in BEAM results in a wide variation in exposure as estimated by both models. Higher melphalan exposure was significantly associated with increased metabolic toxicities but did not seem to impact progression-free survival. Although our study suggests a melphalan AUC of 8 mg·h/L as a potential target in BEAM, larger prospective studies using personalized PK-directed melphalan dosing are needed to determine the optimal melphalan exposure in lymphomas.
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Affiliation(s)
- Parastoo B Dahi
- 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.
| | - Andrew Lin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Scordo
- 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
| | - Jessica R Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Josel D Ruiz
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lauren DeRespiris
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dean Carlow
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christina Cho
- 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
| | - Oscar B Lahoud
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel-Angel Perales
- 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
| | - Craig S Sauter
- 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
| | - Jan Jaap Boelens
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Rick Admiraal
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, the Netherlands; Pediatric Blood and Marrow Transplantation Program, Princes Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sergio A 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
| | - Gunjan L Shah
- 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
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31
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Bernard E, Tuechler H, Greenberg PL, Hasserjian RP, Arango Ossa JE, Nannya Y, Devlin SM, Creignou M, Pinel P, Monnier L, Gundem G, Medina-Martinez JS, Domenico D, Jädersten M, Germing U, Sanz G, van de Loosdrecht AA, Kosmider O, Follo MY, Thol F, Zamora L, Pinheiro RF, Pellagatti A, Elias HK, Haase D, Ganster C, Ades L, Tobiasson M, Palomo L, Della Porta MG, Takaori-Kondo A, Ishikawa T, Chiba S, Kasahara S, Miyazaki Y, Viale A, Huberman K, Fenaux P, Belickova M, Savona MR, Klimek VM, Santos FPS, Boultwood J, Kotsianidis I, Santini V, Solé F, Platzbecker U, Heuser M, Valent P, Ohyashiki K, Finelli C, Voso MT, Shih LY, Fontenay M, Jansen JH, Cervera J, Gattermann N, Ebert BL, Bejar R, Malcovati L, Cazzola M, Ogawa S, Hellström-Lindberg E, Papaemmanuil E. Molecular International Prognostic Scoring System for Myelodysplastic Syndromes. NEJM Evid 2022; 1:EVIDoa2200008. [PMID: 38319256 DOI: 10.1056/evidoa2200008] [Citation(s) in RCA: 238] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
MDS Molecular International Prognostic Scoring SystemSamples from over 2500 patients with MDS were profiled for gene mutations and used to develop the International Prognostic Scoring System-Molecular (IPSS-M). TP53multihit, FLT3 mutations, and MLLPTD were identified as top genetic predictors of adverse outcomes. IPSS-M improves prognostic discrimination across all clinical end points versus prior versions.
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Affiliation(s)
- Elsa Bernard
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | | | | | | | - Juan E Arango Ossa
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Yasuhito Nannya
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
- Division of Hematopoietic Disease Control, Institute of Medical Science, University of Tokyo, Tokyo
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Maria Creignou
- Department of Medicine Huddinge, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Philippe Pinel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Lily Monnier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Gunes Gundem
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Juan S Medina-Martinez
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Dylan Domenico
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Martin Jädersten
- Department of Medicine Huddinge, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany
| | - Guillermo Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, Madrid
- Health Research Institute La Fe, Valencia, Spain
| | - Arjan A van de Loosdrecht
- Department of Hematology, Amsterdam University Medical Center, Vrije University Medical Center, Amsterdam
| | - Olivier Kosmider
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin and Université de Paris, Université Paris Descartes, Paris
| | - Matilde Y Follo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Felicitas Thol
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Lurdes Zamora
- Hematology Department, Hospital Germans Trias i Pujol, Institut Català d'Oncologia, Josep Carreras Leukaemia Research Institute, Barcelona
| | - Ronald F Pinheiro
- Drug Research and Development Center, Federal University of Ceara, Ceara, Brazil
| | - Andrea Pellagatti
- Radcliffe Department of Medicine, Oxford BRC Haematology Theme, University of Oxford, Oxford, United Kingdom
| | - Harold K Elias
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Detlef Haase
- Clinics of Hematology and Medical Oncology, University Medical Center, Göttingen, Germany
| | - Christina Ganster
- Clinics of Hematology and Medical Oncology, University Medical Center, Göttingen, Germany
| | - Lionel Ades
- Department of Hematology, Hôpital St Louis, and Paris University, Paris
| | - Magnus Tobiasson
- Department of Medicine Huddinge, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Laura Palomo
- Myelodysplastic Syndromes Group, Institut de Recerca Contra la Leucèmia Josep Carreras, Barcelona
| | | | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shigeru Chiba
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Senji Kasahara
- Department of Hematology, Gifu Municipal Hospital, Gifu, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Agnes Viale
- Integrated Genomics Operation, Memorial Sloan Kettering Cancer Center, New York
| | - Kety Huberman
- Integrated Genomics Operation, Memorial Sloan Kettering Cancer Center, New York
| | - Pierre Fenaux
- Department of Hematology, Hôpital St Louis, and Paris University, Paris
| | - Monika Belickova
- Department of Genomics, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Michael R Savona
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville
| | - Virginia M Klimek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Fabio P S Santos
- Oncology-Hematology Center, Hospital Israelita Albert Einstein, São Paulo
| | - Jacqueline Boultwood
- Radcliffe Department of Medicine, Oxford BRC Haematology Theme, University of Oxford, Oxford, United Kingdom
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Valeria Santini
- Myelodysplastic syndromes Unit, Department of Experimental and Clinical Medicine, Hematology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesc Solé
- Myelodysplastic Syndromes Group, Institut de Recerca Contra la Leucèmia Josep Carreras, Barcelona
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University of Leipzig, Leipzig, Germany
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna
| | | | - Carlo Finelli
- Institute of Hematology "Seràgnoli," Istituti di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Teresa Voso
- Myelodysplastic syndromes Cooperative Group Gruppo Laziale Mielodisplasie (GROM-L), Department of Biomedicine and Prevention, Tor Vergata University, Rome
| | - Lee-Yung Shih
- Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan
| | - Michaela Fontenay
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin and Université de Paris, Université Paris Descartes, Paris
| | - Joop H Jansen
- Laboratory of Hematology, Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - José Cervera
- Department of Hematology and Genetics Unit, University Hospital La Fe, Valencia, Spain
| | - Norbert Gattermann
- Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany
| | - Benjamin L Ebert
- Department of Medical Oncology, Howard Hughes Medical Institute, Dana-Farber Cancer Center, Boston
| | - Rafael Bejar
- University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Luca Malcovati
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Mario Cazzola
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology, Kyoto University, Kyoto, Japan
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institute, Stockholm
| | - Eva Hellström-Lindberg
- Department of Medicine Huddinge, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Elli Papaemmanuil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
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32
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Fein JA, McAuliffe A, Fischer K, Brady O, Devlin SM, Willumsen S, Ozcan G, Montanaro P, Pristyazhnyuk Y, Digiuseppe J, Perales MA, Pfister DG, Giralt S, Dailey M, Yu PP, Sauter CS. Impact of a shared-care model between community and academic centers for facilitating access to allogeneic and autologous stem cell transplantation. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1510 Background: Despite curative or disease-controlling roles in AML/MDS and MM, access to allogeneic (allo) and autologous (auto) hematopoietic stem cell transplantation (SCT) remains far from universal. Socioeconomic status (SES) and geographic distance from SCT centers have been shown to be barriers to SCT access. In 2016, Hartford HealthCare (HHC) and the Memorial Sloan Kettering Cancer Center (MSK) pioneered a Shared-Care Model (SCM) to streamline access to allo and auto SCT at MSK, featuring a dedicated nurse SCT coordinator, shared hematology tumor boards, MSK-led didactics for HHC providers, and an electronic health record sharing pipeline. We sought to determine if this has improved access to SCT for HHC patients. Methods: A retrospective chart review was conducted of HHC patients aged 18-70 with new diagnoses of AML, MDS, and MM between 2016 and 2020. Socioeconomic status (SES) was estimated by 9-digit zip-code using the Area Deprivation Index (ADI), shown to be a surrogate for healthcare access. Referral or not to a SCT center, referral to MSK through the SCM, and reasons for non-referral were abstracted from the medical record. For patients referred for SCT at MSK, we also captured the number of peri-SCT days in New York City (NYC) and number of subsequent MSK and HHC clinic visits/hospitalizations within 1-year post-SCT. Results: A total of 126 patients was included, with 81 (64%) treated for AML/MDS and 45 (36%) for MM. The median age was 60 years (interquartile range [IQR]: 53-66). The majority were white (n = 101, 80%) followed by 10% (n = 13) Black/African American; 10% (n = 12) were of Hispanic ethnicity. The median ADI percentile was 38 (IQR: 20-51; higher percentiles reflect decreased SES). The median ADI for MSK SCT referrals from New York, New Jersey, and Connecticut 2016-2020 for the same indications was 19 (IQR: 10-30, p < 0.001). A total of 90 patients (71%) were referred to SCT centers. Leading reasons for no referral were favorable-risk disease (n = 10), goals of care (n = 9), and death prior to referral (n = 5); 3 patients were not referred due to comorbidities/performance status. No differences were found between patients referred to MSK vs. other centers. Thirty-four HHC patients were referred to MSK (21 AML/MDS, 13 MM), vs. 3 between 2010 and 2015. Twelve patients underwent allo SCT, with median 97 days in NYC (range: 68-247); 8 underwent auto SCT, with median 21 days in NYC (range: 15-48). Conclusions: Our findings show the feasibility of a shared-care model between a non-SCT-providing large regional hospital system and a major academic transplantation center. Close collaboration between institutions may minimize time patients spend away from home. The SES of HHC referrals was lower than the general MSK population, suggesting that a shared-care model may facilitate access to SCT for patients with previous barriers for this potentially curative therapy.
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Affiliation(s)
| | | | | | - Owen Brady
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark Dailey
- Hartford HealthCare Cancer Institute, Hartford, CT
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33
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Andrlová H, Miltiadous O, Kousa AI, Dai A, DeWolf S, Violante S, Park HY, Janaki-Raman S, Gardner R, El Daker S, Slingerland J, Giardina P, Clurman A, Gomes ALC, Nguyen C, da Silva MB, Armijo GK, Lee N, Zappasodi R, Chaligne R, Masilionis I, Fontana E, Ponce D, Cho C, Bush A, Hill L, Chao N, Sung AD, Giralt S, Vidal EH, Hosszu KK, Devlin SM, Peled JU, Cross JR, Perales MA, Godfrey DI, van den Brink MRM, Markey KA. MAIT and Vδ2 unconventional T cells are supported by a diverse intestinal microbiome and correlate with favorable patient outcome after allogeneic HCT. Sci Transl Med 2022; 14:eabj2829. [PMID: 35613281 PMCID: PMC9893439 DOI: 10.1126/scitranslmed.abj2829] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 02/04/2023]
Abstract
Microbial diversity is associated with improved outcomes in recipients of allogeneic hematopoietic cell transplantation (allo-HCT), but the mechanism underlying this observation is unclear. In a cohort of 174 patients who underwent allo-HCT, we demonstrate that a diverse intestinal microbiome early after allo-HCT is associated with an increased number of innate-like mucosal-associated invariant T (MAIT) cells, which are in turn associated with improved overall survival and less acute graft-versus-host disease (aGVHD). Immune profiling of conventional and unconventional immune cell subsets revealed that the prevalence of Vδ2 cells, the major circulating subpopulation of γδ T cells, closely correlated with the frequency of MAIT cells and was associated with less aGVHD. Analysis of these populations using both single-cell transcriptomics and flow cytometry suggested a shift toward activated phenotypes and a gain of cytotoxic and effector functions after transplantation. A diverse intestinal microbiome with the capacity to produce activating ligands for MAIT and Vδ2 cells appeared to be necessary for the maintenance of these populations after allo-HCT. These data suggest an immunological link between intestinal microbial diversity, microbe-derived ligands, and maintenance of unconventional T cells.
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Affiliation(s)
- Hana Andrlová
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oriana Miltiadous
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anastasia I Kousa
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anqi Dai
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan DeWolf
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sara Violante
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hee-Yon Park
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sudha Janaki-Raman
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rui Gardner
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sary El Daker
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Slingerland
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Giardina
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annelie Clurman
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Antonio L C Gomes
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chi Nguyen
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Louis V. Gerstner Jr. Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marina Burgos da Silva
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gabriel K Armijo
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole Lee
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roberta Zappasodi
- Human Oncology Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Ronan Chaligne
- Program for Computational and Systems Biology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ignas Masilionis
- Program for Computational and Systems Biology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily Fontana
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Doris Ponce
- Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christina Cho
- Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amy Bush
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Lauren Hill
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Nelson Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Sergio Giralt
- Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Esther H Vidal
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kinga K Hosszu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan U Peled
- Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin R Cross
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dale I Godfrey
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Marcel R M van den Brink
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kate A Markey
- Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA, USA
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
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34
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Miltiadous O, Waters NR, Andrlová H, Dai A, Nguyen CL, Burgos da Silva M, Lindner S, Slingerland J, Giardina P, Clurman A, Armijo GK, Gomes ALC, Lakkaraja M, Maslak P, Scordo M, Shouval R, Staffas A, O'Reilly R, Taur Y, Prockop S, Boelens JJ, Giralt S, Perales MA, Devlin SM, Peled JU, Markey KA, van den Brink MRM. Early intestinal microbial features are associated with CD4 T-cell recovery after allogeneic hematopoietic transplant. Blood 2022; 139:2758-2769. [PMID: 35061893 PMCID: PMC9074404 DOI: 10.1182/blood.2021014255] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/23/2021] [Indexed: 11/20/2022] Open
Abstract
Low intestinal microbial diversity is associated with poor outcomes after allogeneic hematopoietic cell transplantation (HCT). Using 16S rRNA sequencing of 2067 stool samples and flow cytometry data from 2370 peripheral blood samples drawn from 894 patients who underwent allogeneic HCT, we have linked features of the early post-HCT microbiome with subsequent immune cell recovery. We examined lymphocyte recovery and microbiota features in recipients of both unmodified and CD34-selected allografts. We observed that fecal microbial diversity was an independent predictor of CD4 T-cell count 3 months after HCT in recipients of a CD34-selected allograft, who are dependent on de novo lymphopoiesis for their immune recovery. In multivariate models using clinical factors and microbiota features, we consistently observed that increased fecal relative abundance of genus Staphylococcus during the early posttransplant period was associated with worse CD4 T-cell recovery. Our observations suggest that the intestinal bacteria, or the factors they produce, can affect early lymphopoiesis and the homeostasis of allograft-derived T cells after transplantation.
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Affiliation(s)
- Oriana Miltiadous
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicholas R Waters
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Hana Andrlová
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Anqi Dai
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Chi L Nguyen
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Marina Burgos da Silva
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Sarah Lindner
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - John Slingerland
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Paul Giardina
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Annelie Clurman
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Gabriel K Armijo
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Antonio L C Gomes
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Madhavi Lakkaraja
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Peter Maslak
- Immunology Laboratory Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Michael Scordo
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roni Shouval
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anna Staffas
- Sahlgrenska Center for Cancer Research, Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Sweden
- Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Richard O'Reilly
- Stem Cell Transplant and Cellular Therapy Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ying Taur
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Susan Prockop
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
- Stem Cell Transplant and Cellular Therapy Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jaap Jan Boelens
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
- Stem Cell Transplant and Cellular Therapy Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Miguel-Angel Perales
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan U Peled
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kate A Markey
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Clinical Research Division, Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA; and
- Division of Medical Oncology, University of Washington, Seattle, WA
| | - Marcel R M van den Brink
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Smith M, Dai A, Ghilardi G, Amelsberg KV, Devlin SM, Pajarillo R, Slingerland JB, Beghi S, Herrera PS, Giardina P, Clurman A, Dwomoh E, Armijo G, Gomes ALC, Littmann ER, Schluter J, Fontana E, Taur Y, Park JH, Palomba ML, Halton E, Ruiz J, Jain T, Pennisi M, Afuye AO, Perales MA, Freyer CW, Garfall A, Gier S, Nasta S, Landsburg D, Gerson J, Svoboda J, Cross J, Chong EA, Giralt S, Gill SI, Riviere I, Porter DL, Schuster SJ, Sadelain M, Frey N, Brentjens RJ, June CH, Pamer EG, Peled JU, Facciabene A, van den Brink MRM, Ruella M. Gut microbiome correlates of response and toxicity following anti-CD19 CAR T cell therapy. Nat Med 2022; 28:713-723. [PMID: 35288695 PMCID: PMC9434490 DOI: 10.1038/s41591-022-01702-9] [Citation(s) in RCA: 107] [Impact Index Per Article: 53.5] [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: 04/08/2021] [Accepted: 01/13/2022] [Indexed: 01/29/2023]
Abstract
Anti-CD19 chimeric antigen receptor (CAR) T cell therapy has led to unprecedented responses in patients with high-risk hematologic malignancies. However, up to 60% of patients still experience disease relapse and up to 80% of patients experience CAR-mediated toxicities, such as cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. We investigated the role of the intestinal microbiome on these outcomes in a multicenter study of patients with B cell lymphoma and leukemia. We found in a retrospective cohort (n = 228) that exposure to antibiotics, in particular piperacillin/tazobactam, meropenem and imipenem/cilastatin (P-I-M), in the 4 weeks before therapy was associated with worse survival and increased neurotoxicity. In stool samples from a prospective cohort of CAR T cell recipients (n = 48), the fecal microbiome was altered at baseline compared to healthy controls. Stool sample profiling by 16S ribosomal RNA and metagenomic shotgun sequencing revealed that clinical outcomes were associated with differences in specific bacterial taxa and metabolic pathways. Through both untargeted and hypothesis-driven analysis of 16S sequencing data, we identified species within the class Clostridia that were associated with day 100 complete response. We concluded that changes in the intestinal microbiome are associated with clinical outcomes after anti-CD19 CAR T cell therapy in patients with B cell malignancies.
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Affiliation(s)
- Melody Smith
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University School of Medicine, Stanford, CA, USA
| | - Anqi Dai
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guido Ghilardi
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly V Amelsberg
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sean M Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymone Pajarillo
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - John B Slingerland
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Silvia Beghi
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela S Herrera
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Paul Giardina
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annelie Clurman
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emmanuel Dwomoh
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gabriel Armijo
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Antonio L C Gomes
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric R Littmann
- The Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Jonas Schluter
- Institute for Computational Medicine, New York University Langone Health, New York, NY, USA
| | - Emily Fontana
- Molecular Microbiology Core Facility, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying Taur
- Infectious Disease Service, Department of Medicine, and Immunology Program, Sloan Kettering Institute, New York, NY, USA
| | - Jae H Park
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Lia Palomba
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Halton
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Josel Ruiz
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tania Jain
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Martina Pennisi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Aishat Olaide Afuye
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Craig W Freyer
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Alfred Garfall
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
| | - Shannon Gier
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunita Nasta
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Landsburg
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - James Gerson
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jakub Svoboda
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Justin Cross
- The Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elise A Chong
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Saar I Gill
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Isabelle Riviere
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David L Porter
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Schuster
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Michel Sadelain
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Noelle Frey
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Renier J Brentjens
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carl H June
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | - Eric G Pamer
- The Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Jonathan U Peled
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Andrea Facciabene
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Ovarian Cancer Research Center, University of Pennsylvania, Philadelphia, PA, USA.
| | - Marcel R M van den Brink
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Immunology, Sloan Kettering Institute, New York, NY, USA.
| | - Marco Ruella
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
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Politikos I, Flynn J, Devlin SM, Fingrut W, Maloy MA, Naputo K, Chinapen S, Rodriguez NT, Quach S, Dominguez Y, Scaradavou A, Roshal M, Cho C, Dahi PB, Gyurkocza B, Jakubowski AA, Papadopoulos EB, Ponce DM, Sauter CS, Shaffer BC, Tamari R, Scordo M, Young J, Giralt SA, Perales MA, Barker JN. Double Unit Cord Blood Transplantation Compares Favorably to T-Cell Depleted Matched Adult Donor Transplantation for the Treatment of Acute Leukemia Due to a Robust Protection Against Relapse. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00205-6] [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: 10/18/2022]
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Politikos I, Lau C, Devlin SM, Naputo K, Quach S, Chinapen S, Lin A, Papadopoulos EB, Perales MA, Shah G, Seo SK, Papanicolaou GA, Barker JN. Extended Letermovir Prophylaxis Is Highly Effective Cytomegalovirus (CMV) Infection Prevention in Adult Cord Blood Transplantation (CBT) Recipients & Does Not Prevent Emergence of CMV-Specific Donor-Derived Immunity. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jimenez Jimenez AM, Perales MA, Devlin SM, Brown S, Lekakis LJ, Sauter CS, Pereira D, Wang TP, Ponce DM, Beitinjaneh A, Chinapen S, Goodman M, Komanduri KV, Shaffer BC. Post-Transplant Cyclophosphamide (PTCy) Is Associated with Superior Gvhd-Free, Relapse-Free Survival (GRFS) in HLA-Mismatched Unrelated Donor (MMUD) Hematopoietic Cell Transplantation. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rodich L, Adintori PA, Flynn J, Devlin SM, Ruiz JD, Gossman Z, Shike M, Barker JN, Jakubowski AA, Kernan NA, Markova A, Ponce DM, Perales MA, Giralt SA, DeRespiris L, Dahi PB. Peri-Transplant Vitamin and Micronutrient Status in Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cho C, Maloy MA, Devlin SM, Aras O, Dauer LT, Jakubowski AA, Papadopoulos EB, Perales MA, Rappaport TS, Giralt SA. Ionizing radiation exposure after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2022; 57:827-829. [DOI: 10.1038/s41409-022-01612-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 12/18/2022]
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Shouval R, Alarcon Tomas A, Fein JA, Flynn JR, Markovits E, Mayer S, Olaide Afuye A, Alperovich A, Anagnostou T, Besser MJ, Batlevi CL, Dahi PB, Devlin SM, Fingrut WB, Giralt SA, Lin RJ, Markel G, Salles G, Sauter CS, Scordo M, Shah GL, Shah N, Scherz-Shouval R, van den Brink M, Perales MA, Palomba ML. Impact of TP53 Genomic Alterations in Large B-Cell Lymphoma Treated With CD19-Chimeric Antigen Receptor T-Cell Therapy. J Clin Oncol 2022; 40:369-381. [PMID: 34860572 PMCID: PMC8797602 DOI: 10.1200/jco.21.02143] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Tumor-intrinsic features may render large B-cell lymphoma (LBCL) insensitive to CD19-directed chimeric antigen receptor T cells (CAR-T). We hypothesized that TP53 genomic alterations are detrimental to response outcomes in LBCL treated with CD19-CAR-T. MATERIALS AND METHODS Patients with LBCL treated with CD19-CAR-T were included. Targeted next-generation sequencing was performed on pre-CAR-T tumor samples in a subset of patients. Response and survival rates by histologic, cytogenetic, and molecular features were assessed. Within a cohort of newly diagnosed LBCL with genomic and transcriptomic profiling, we studied interactions between cellular pathways and TP53 status. RESULTS We included 153 adults with relapsed or refractory LBCL treated with CD19-CAR-T (axicabtagene ciloleucel [50%], tisagenlecleucel [32%], and lisocabtagene maraleucel [18%]). Outcomes echoed pivotal trials: complete response (CR) rate 54%, median overall survival (OS) 21.1 months (95% CI, 14.8 to not reached), and progression-free survival 6 months (3.4 to 9.7). Histologic and cytogenetic LBCL features were not predictive of CR. In a subset of 82 patients with next-generation sequencing profiling, CR and OS rates were comparable with the unsequenced cohort. TP53 alterations (mutations and/or copy number alterations) were common (37%) and associated with inferior CR and OS rates in univariable and multivariable regression models; the 1-year OS in TP53-altered LBCL was 44% (95% CI, 29 to 67) versus 76% (65 to 89) in wild-type (P = .012). Transcriptomic profiling from a separate cohort of patients with newly diagnosed lymphoma (n = 562) demonstrated that TP53 alterations are associated with dysregulation of pathways related to CAR-T-cell cytotoxicity, including interferon and death receptor signaling pathway and reduced CD8 T-cell tumor infiltration. CONCLUSION TP53 is a potent tumor-intrinsic biomarker that can inform risk stratification and clinical trial design in patients with LBCL treated with CD19-CAR-T. The role of TP53 should be further validated in independent cohorts.
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Affiliation(s)
- Roni Shouval
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY,Roni Shouval, MD, PhD, Memorial Sloan Kettering Cancer Center, Koch Center, 530 E74th St, New York, NY 10021; e-mail:
| | - Ana Alarcon Tomas
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY,Cell Therapy and Translational Medicine, University of Murcia, Murcia, Spain
| | - Joshua A. Fein
- University of Connecticut Medical Center, Farmington, CT
| | - Jessica R. Flynn
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ettai Markovits
- Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shimrit Mayer
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Aishat Olaide Afuye
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anna Alperovich
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theodora Anagnostou
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Hematology and Medical Oncology, and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michal J. Besser
- Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Chaim Sheba Medical Center, Ramat Gan, Israel,Department of Clinical Microbiology & Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Connie Lee Batlevi
- Weill Cornell Medical College, New York, NY,Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Parastoo B. Dahi
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
| | - Sean M. Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Warren B. Fingrut
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio A. Giralt
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
| | - Richard J. Lin
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
| | - Gal Markel
- Department of Clinical Microbiology & Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilles Salles
- Weill Cornell Medical College, New York, NY,Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Craig S. Sauter
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
| | - Michael Scordo
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
| | - Gunjan L. Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
| | - Nishi Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ruth Scherz-Shouval
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Marcel van den Brink
- Department of Medicine, Adult Bone Marrow Transplantation 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 Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
| | - Maria Lia Palomba
- Weill Cornell Medical College, New York, NY,Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
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Abstract
Many clinical trials incorporate stopping rules to terminate early if the clinical question under study can be answered with a high degree of confidence. While common in later-stage trials, these rules are rarely implemented in dose escalation studies, due in part to the relatively smaller sample size of these designs. However, even with a small sample size, this paper shows that easily implementable stopping rules can terminate dose-escalation early with minimal loss to the accuracy of maximum tolerated dose estimation. These stopping rules are developed when the goal is to identify one or two dose levels, as the maximum tolerated dose and co-maximum tolerated dose. In oncology, this latter goal is frequently considered when the study includes dose-expansion cohorts, which are used to further estimate and compare the safety and efficacy of one or two dose levels. As study protocols do not typically halt accrual between escalation and expansion, early termination is of clinical importance as it either allows for additional patients to be treated as part of the dose expansion cohort to obtain more precise estimates of the study endpoints or allows for an overall reduction in the total sample size.
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Affiliation(s)
| | | | - John O’Quigley
- Department of Statistical Science, University College London, U.K
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Devlin SM, Martin A, Ostrovnaya I. Identifying prognostic pairwise relationships among bacterial species in microbiome studies. PLoS Comput Biol 2021; 17:e1009501. [PMID: 34752448 PMCID: PMC8631663 DOI: 10.1371/journal.pcbi.1009501] [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: 03/03/2020] [Revised: 11/30/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
In recent literature, the human microbiome has been shown to have a major influence on human health. To investigate this impact, scientists study the composition and abundance of bacterial species, commonly using 16S rRNA gene sequencing, among patients with and without a disease or condition. Methods for such investigations to date have focused on the association between individual bacterium and an outcome, and higher-order pairwise relationships or interactions among bacteria are often avoided due to the substantial increase in dimension and the potential for spurious correlations. However, overlooking such relationships ignores the environment of the microbiome, where there is dynamic cooperation and competition among bacteria. We present a method for identifying and ranking pairs of bacteria that have a differential dichotomized relationship across outcomes. Our approach, implemented in an R package PairSeek, uses the stability selection framework with data-driven dichotomized forms of the pairwise relationships. We illustrate the properties of the proposed method using a published oral cancer data set and a simulation study. Within an ecological system, microbial communities represent complex relationships between bacteria, where they co-exist and interact with each other in multiple ways including cooperation and competition. Most existing statistical tools for examining the association between microbiota and a disease state, such as individuals with and without cancer, focus on individual bacterium in isolation, ignoring the dynamic environment in which it lives. In this manuscript, we propose an algorithm for assessing the association between pairs of bacteria and a disease state. The approach provides a mechanism to rank pairs of bacteria, from pairs with the most evidence of an association with the disease state to the least amount of evidence. This ranking helps generate hypotheses and prioritize bacteria for further investigation. We illustrate the algorithm using a publicly available data set of oral cancer patients.
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Affiliation(s)
- Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, United States of America
| | - Axel Martin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, United States of America
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, United States of America
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Chung DJ, Shah GL, Devlin SM, Ramanathan LV, Doddi S, Pessin MS, Hoover E, Marcello LT, Young JC, Boutemine SR, Serrano E, Sharan S, Momotaj S, Margetich L, Bravo CD, Papanicolaou GA, Kamboj M, Mato AR, Roeker LE, Hultcrantz M, Mailankody S, Lesokhin AM, Vardhana SA, Knorr DA. Disease- and Therapy-Specific Impact on Humoral Immune Responses to COVID-19 Vaccination in Hematologic Malignancies. Blood Cancer Discov 2021; 2:568-576. [PMID: 34778797 PMCID: PMC8580617 DOI: 10.1158/2643-3230.bcd-21-0139] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/31/2021] [Accepted: 09/09/2021] [Indexed: 12/30/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) vaccine response data for patients with hematologic malignancy, who carry high risk for severe COVID-19 illness, are incomplete. In a study of 551 hematologic malignancy patients with leukemia, lymphoma, and multiple myeloma, anti-SARS-CoV-2 spike IgG titers and neutralizing activity were measured at 1 and 3 months from initial vaccination. Compared with healthy controls, patients with hematologic malignancy had attenuated antibody titers at 1 and 3 months. Furthermore, patients with hematologic malignancy had markedly diminished neutralizing capacity of 26.3% at 1 month and 43.6% at 3 months, despite positive seroconversion rates of 51.5% and 68.9% at the respective time points. Healthy controls had 93.2% and 100% neutralizing capacity at 1 and 3 months, respectively. Patients with leukemia, lymphoma, and multiple myeloma on observation had uniformly blunted responses. Treatment with Bruton tyrosine kinase inhibitors, venetoclax, phosphoinositide 3-kinase inhibitors, anti-CD19/CD20-directed therapies, and anti-CD38/B-cell maturation antigen-directed therapies substantially hindered responses, but single-agent immunomodulatory agents did not. Significance Patients with hematologic malignancy have compromised COVID-19 vaccine responses at baseline that are further suppressed by active therapy, with many patients having insufficient neutralizing capacity despite positive antibody titers. Refining vaccine response parameters is critical to guiding clinical care, including the indication for booster vaccines, for this vulnerable population.See related article by Tamari et al., p. 577. This article is highlighted in the In This Issue feature, p. 549.
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Affiliation(s)
- David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), 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 (MSKCC), New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, MSKCC, New York, New York
| | | | - Sital Doddi
- Department of Laboratory Medicine, MSKCC, New York, New York
| | | | - Elizabeth Hoover
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
| | - LeeAnn T Marcello
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
| | - Jennifer C Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
| | | | - Edith Serrano
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Saumya Sharan
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Saddia Momotaj
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Lauren Margetich
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | | | | | - Mini Kamboj
- Infectious Disease Service, Department of Medicine, MSKCC, New York, New York
| | - Anthony R Mato
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Lindsey E Roeker
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Malin Hultcrantz
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Sham Mailankody
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Alexander M Lesokhin
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Santosha A Vardhana
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Lymphoma Service, Department of Medicine, MSKCC, New York, New York
- Human Oncology and Pathogenesis Program, MSKCC, New York, New York
| | - David A Knorr
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
- The Rockefeller University, New York, New York
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Tamari R, Politikos I, Knorr DA, Vardhana SA, Young JC, Marcello LT, Doddi S, Devlin SM, Ramanathan LV, Pessin MS, Dunn E, Palazzo M, Bravo CD, Papanicolaou GA, Kamboj M, Perales MA, Chung DJ, Shah GL. Predictors of Humoral Response to SARS-CoV-2 Vaccination after Hematopoietic Cell Transplantation and CAR T-cell Therapy. Blood Cancer Discov 2021; 2:577-585. [PMID: 34778798 PMCID: PMC8580614 DOI: 10.1158/2643-3230.bcd-21-0142] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 01/11/2023] Open
Abstract
Cellular therapies including allogeneic hematopoietic cell transplant (allo-HCT) and autologous hematopoietic cell transplant (auto-HCT) and chimeric antigen receptor (CAR) T-cell therapy render patients severely immunocompromised for extended periods after therapy, and data on responses to COVID-19 vaccines are limited. We analyzed anti-SARS-CoV-2 spike IgG Ab (spike Ab) titers and neutralizing Ab among 217 recipients of cellular treatments (allo-HCT, n = 149; auto-HCT, n = 61; CAR T-cell therapy, n = 7). At 3 months after vaccination, 188 patients (87%) had positive spike Ab levels and 139 (77%) had positive neutralization activity compared with 100% for both in 54 concurrent healthy controls. Time from cellular therapy to vaccination and immune recovery post-cellular therapy were associated with response. Vaccination against COVID-19 is an important component of post-cellular therapy care, and predictors of quantitative and qualitative response are critical in informing clinical decisions about optimal timing of vaccines and the requirement for booster doses. Significance Identifying predictors of response to vaccination against SARS-CoV-2 in patients following cellular therapy is critical to managing this highly vulnerable patient population. To date, this is the most comprehensive study evaluating quantitative and qualitative responses to vaccination, providing parameters most predictive of response and potentially informing booster vaccination strategies.See related article by Chung et al., p. 568. This article is highlighted in the In This Issue feature, p. 549.
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Affiliation(s)
- 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
| | - 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
| | - David A Knorr
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Santosha A Vardhana
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer C Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - LeeAnn T Marcello
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sital Doddi
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lakshmi V Ramanathan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa S Pessin
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica Dunn
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meighan Palazzo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christina D Bravo
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Genovefa A Papanicolaou
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mini Kamboj
- 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
| | - 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
| | - 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
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Tamari R, Brown S, Devlin SM, Kosuri S, Maloy MA, Ponce DM, Sauter C, Shaffer B, Dahi P, Young JW, Jakubowski A, Papadopoulos EB, Castro-Malaspina H, Perales MA, Giralt SA, Gyurkocza B. Fractionated Infusion of Hematopoietic Progenitor Cells Does Not Improve Neutrophil Recovery or Survival in Allograft Recipients. Transplant Cell Ther 2021; 27:852.e1-852.e9. [PMID: 34214736 PMCID: PMC8478895 DOI: 10.1016/j.jtct.2021.06.022] [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: 04/21/2021] [Revised: 06/11/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) offers a potentially curative therapy in patients with hematologic malignancies; however, nonrelapse mortality (NRM) remains a concern. Strategies to improve neutrophil recovery and immune reconstitution are needed to decrease NRM. Murine models of allogeneic HCT suggest that fractionated hematopoietic progenitor cell (HPC) infusion may improve engraftment through improved access of HPCs to a viable hematopoietic niche. The primary objective of the present study was to determine the impact of fractionated infusion versus unfractionated (bulk) infusion of HPCs on the time to achieve neutrophil engraftment. Secondary objectives included the effect of fractionated versus bulk infusion of HPCs on platelet engraftment, immune reconstitution, the incidence of acute graft-versus-host disease (GVHD) grade II-IV, NRM, and overall survival (OS). In this randomized phase 2 study, patients with hematologic malignancies undergoing allogeneic HCT were randomized to receive HPC infusion as a bulk (bulk arm) or in fractions (fractionated arm): 4 × 106 CD34+ cells/kg recipient weight infused on day 0, with the remaining HPCs CD34+ cell-selected then infused in equally distributed aliquots on days 2, 4, and 6 post-HCT. Randomization was stratified by type of transplant, unmodified (i.e. T cell-replete graft) versus CD34+ cell-selected (T cell-depleted graft). Patients whose donor failed to collect at least 7 × 106 CD34+ cells/kg of recipient weight received bulk HPC infusions regardless of randomization, for safety. These patients continued the HCT process on study but were replaced until each arm reached the prespecified accrual target. Per protocol, these patients were not included in this modified intention-to-treat analysis. A total of 116 patients were enrolled. Donors of 42 patients failed to mobilize the minimum CD34+ cell dose (7 × 106 cells/kg recipient weight) and were excluded from the analysis. The 74 evaluable patients included 38 randomized to the bulk arm and 36 randomized to the fractionated arm. All patients engrafted. The median time to an absolute neutrophil count of ≥0.5 × 109/L was 11 days on both arms. The day +180 median CD4+ cell count was 179 cells/µL in the bulk arm and 111 cells/µL in the fractionated arm (P = .779). The cumulative incidence of grade II-IV acute GVHD on post-transplant day +100 was 32% in the bulk arm and 17% in the fractionated arm (P = .131). Two patients in the bulk arm, but none in the fractionated arm, experienced grade III-IV GVHD. The 4-year OS was 60% in the bulk arm and 62% in the fractionated arm (P = .414), whereas the 4-year cumulative incidences of NRM and relapse were similar in the 2 arms. Fractionated infusion of HPCs in allogeneic HCT recipients did not impact neutrophil or CD4+ cell recovery, NRM, relapse, or OS when compared with bulk HPC infusion. We also observed that with current mobilization techniques, it was unlikely that more than 60% of healthy donors would be able to collect >7 × 106 CD34+ cells/kg recipient weight for adult recipients. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Roni Tamari
- Adult Blood and 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
| | - Samantha Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Satyajit Kosuri
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Molly A Maloy
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Doris M Ponce
- Adult Blood and 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
- Adult Blood and 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
| | - Brian Shaffer
- Adult Blood and 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 Dahi
- Adult Blood and 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
| | - James W Young
- Adult Blood and 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; The Rockefeller University, New York, New York
| | - Ann Jakubowski
- Adult Blood and 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 B Papadopoulos
- Adult Blood and 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
| | - Hugo Castro-Malaspina
- Adult Blood and 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 Blood and 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 Blood and 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 Blood and 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.
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Geyer MB, Ritchie EK, Rao AV, Vemuri S, Flynn J, Hsu M, Devlin SM, Roshal M, Gao Q, Shukla M, Salcedo JM, Maslak P, Tallman MS, Douer D, Park JH. Pediatric-inspired chemotherapy incorporating pegaspargase is safe and results in high rates of minimal residual disease negativity in adults up to age 60 with Philadelphia chromosome-negative acute lymphoblastic leukemia. Haematologica 2021; 106:2086-2094. [PMID: 33054114 PMCID: PMC8327717 DOI: 10.3324/haematol.2020.251686] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 03/23/2020] [Indexed: 11/23/2022] Open
Abstract
Administration of pediatric-inspired chemotherapy to adults up to age 60 with acute lymphoblastic leukemia (ALL) is challenging in part due to toxicities of asparaginase as well as myelosuppression. We conducted a multi-center phase II clinical trial (clinicaltrials gov. Identifier: NCT01920737) investigating a pediatric-inspired regimen, based on the augmented arm of the Children’s Cancer Group 1882 protocol, incorporating six doses of pegaspargase 2,000 IU/m2, rationally synchronized to avoid overlapping toxicity with other agents. We treated 39 adults aged 20-60 years (median age 38 years) with newly-diagnosed ALL (n=31) or lymphoblastic lymphoma (n=8). Grade 3-4 hyperbilirubinemia occurred frequently and at higher rates in patients aged 40-60 years (n=18) versus 18-39 years (n=21) (44% vs. 10%, P=0.025). However, eight of nine patients rechallenged with pegaspargase did not experience recurrent grade 3-4 hyperbilirubinemia. Grade 3-4 hypertriglyceridemia and hypofibrinogenemia were common (each 59%). Asparaginase activity at 7 days post-infusion reflected levels associated with adequate asparagine depletion, even among those with antibodies to pegaspargase. Complete response (CR)/CR with incomplete hematologic recovery was observed post-induction in 38 of 39 (97%) patients. Among patients with ALL, rates of minimal residual disease negativity by multi-parameter flow cytometry were 33% and 83% following induction phase I and phase II, respectively. Event-free and overall survival at 3 years (67.8% and 76.4%) compare favorably to outcomes observed in other series. These results demonstrate pegaspargase can be administered in the context of intensive multi-agent chemotherapy to adults aged ≤60 years with manageable toxicity. This regimen may serve as an effective backbone into which novel agents may be incorporated in future frontline studies. Trial registration: https://clinicaltrials. gov/ct2/show/NCT01920737
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Affiliation(s)
- Mark B Geyer
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Center for Cell Engineering, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Ellen K Ritchie
- Weill Cornell Medical College, Hematology and Medical Oncology, Joan and Sanford I. Weill Department of Medicine, New York
| | | | | | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Mikhail Roshal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Qi Gao
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Madhulika Shukla
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Jose M Salcedo
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Peter Maslak
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Dan Douer
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Center for Cell Engineering, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
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Korde N, Mastey D, Tavitian E, Mailankody S, Lesokhin A, Hassoun H, Smith EL, Lendvai N, Hultcrantz M, Shah U, Tan C, Lu S, Diamond B, Salcedo M, Werner K, Chung DJ, Scordo M, Shah GL, Lahoud O, Landau H, Arcila M, Ho C, Roshal M, Dogan A, Derkach A, Devlin SM, Giralt SA, Landgren O. Tailored treatment to MRD response: A phase I/II study for newly diagnosed multiple myeloma patients using high dose twice-weekly carfilzomib (45 and 56 mg/m 2 ) in combination with lenalidomide and dexamethasone. Am J Hematol 2021; 96:E193-E196. [PMID: 33661527 PMCID: PMC8251553 DOI: 10.1002/ajh.26150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Neha Korde
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Cornell Medical College New York New York USA
| | - Donna Mastey
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Elizabet Tavitian
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Sham Mailankody
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Cornell Medical College New York New York USA
| | - Alexander Lesokhin
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Cornell Medical College New York New York USA
| | - Hani Hassoun
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Cornell Medical College New York New York USA
| | - Eric L. Smith
- Medical Oncology Dana‐Farber Cancer Institute New York New York USA
| | - Nikoletta Lendvai
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Malin Hultcrantz
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Cornell Medical College New York New York USA
| | - Urvi Shah
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Cornell Medical College New York New York USA
| | - Carlyn Tan
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Cornell Medical College New York New York USA
| | - Sydney Lu
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Cornell Medical College New York New York USA
| | - Benjamin Diamond
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Meghan Salcedo
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Kelly Werner
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - David J. Chung
- Department of Medicine Weill Cornell Medical College New York New York USA
- Adult Bone Marrow Transplant Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Michael Scordo
- Department of Medicine Weill Cornell Medical College New York New York USA
- Adult Bone Marrow Transplant Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Gunjan L. Shah
- Department of Medicine Weill Cornell Medical College New York New York USA
- Adult Bone Marrow Transplant Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Oscar Lahoud
- Department of Medicine Weill Cornell Medical College New York New York USA
- Adult Bone Marrow Transplant Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Heather Landau
- Department of Medicine Weill Cornell Medical College New York New York USA
- Adult Bone Marrow Transplant Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Maria Arcila
- Hematopathology Services Memorial Sloan Kettering Cancer Center New York New York USA
| | - Caleb Ho
- Hematopathology Services Memorial Sloan Kettering Cancer Center New York New York USA
| | - Mikhail Roshal
- Hematopathology Services Memorial Sloan Kettering Cancer Center New York New York USA
| | - Ahmet Dogan
- Hematopathology Services Memorial Sloan Kettering Cancer Center New York New York USA
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Sean M. Devlin
- Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Sergio A. Giralt
- Department of Medicine Weill Cornell Medical College New York New York USA
- Medical Oncology Dana‐Farber Cancer Institute New York New York USA
| | - Ola Landgren
- Multiple Myeloma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Myeloma Program, Sylvester Comprehensive Cancer Center University of Miami New York New York USA
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Zuanelli Brambilla C, Lobaugh SM, Ruiz JD, Dahi PB, Goldberg AD, Young JW, Gyurkocza B, Shaffer BC, Ponce DM, Tamari R, Sanchez Escamilla M, Castillo Flores N, Politikos I, Scordo M, Shah GL, Cho C, Lin RJ, Maloy MA, Devlin SM, Jakubowski AA, Berman E, Stein EM, Papadopoulos EB, Perales MA, Tallman MS, Giralt SA, Smith M. Relapse after Allogeneic Stem Cell Transplantation of Acute Myelogenous Leukemia and Myelodysplastic Syndrome and the Importance of Second Cellular Therapy. Transplant Cell Ther 2021; 27:771.e1-771.e10. [PMID: 34033977 DOI: 10.1016/j.jtct.2021.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 03/14/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 10/01/2022]
Abstract
Patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) who relapse after allogeneic hematopoietic cell transplantation (allo-HCT) generally have poor overall survival (OS). Interventions that result in improved OS after relapse are not well established. The efficacy of second cellular therapy and specific indications are matters of debate. This study was conducted to evaluate factors associated with postrelapse survival and the efficacy of a second course of cellular therapy. We retrospectively analyzed consecutive patients with AML and MDS who underwent a first allo-HCT between 2010 and 2017 at our center but subsequently relapsed. One hundred and four patients with AML and 44 patients with MDS were included (total n = 148). Bone marrow (BM) and peripheral blood stem cell grafts were either unmodified or T cell-depleted (TCD) by CD34+ selection ex vivo. Forty-five patients (30.4%) received a second cellular therapy after relapse, either a second allo-HCT (n = 28; 18.9%) or donor leukocyte infusion (DLI) (n = 17; 11.5%). The median age at transplantation was 60 years (range, 24 to 78 years). The median time to relapse (TTR) after transplantation was 6.5 months (range, 1 to 60.9 months), and the ensuing median OS was 6 months (95% confidence interval [CI], 4.8 to 8.9 months). In univariable analysis, longer TTR, relapse type (measurable residual disease versus morphologic), relapse occurring in the most recent years, and receipt of cellular therapy after relapse were associated with better outcomes, whereas adverse cytogenetics and/or abnormality of TP53, as well as NPM1 mutation in patients with AML, were associated with adverse outcomes. Relapse type, year of relapse, and a variable resulting from the combination of TTR and receipt of second cellular therapy remained significantly associated with postrelapse survival in multivariable analysis. In a separate multivariable model, adjusted only for TTR, relapse type, and receipt of second cellular therapy, an adverse effect of NPM1 mutation on survival was confirmed. We could not show an effect of post-transplantation maintenance on survival after relapse. In both univariable and multivariable analysis, we found a positive association for second cellular therapy with survival after relapse in patients who relapsed early (<6 months) after allo-HCT and a similar trend in patients who relapsed late (>12 months) after transplantation. Two-year OS after a second cellular therapy was 44.9% (95% CI, 28.5% to 61.4%), and it was significantly better in patients with <5% BM blasts before cell infusion. We could not show different effects on survival after second cellular therapy for DLI versus second allo-HCT in univariable analysis. Survival after relapse is improving over time, but this remains a challenging event, especially for patients who relapse early after transplantation. We found that a second cellular therapy could offer a benefit even in these cases. Nonetheless, more research is needed to clarify the most appropriate treatment choices after relapse. These are probably driven by underlying genetic and immunologic conditions, which should be the focus of future studies.
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Affiliation(s)
- Corrado Zuanelli Brambilla
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medical Biotechnologies, University of Siena, Siena, Italy; Hematology Unit, Department of Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Stephanie M Lobaugh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Josel D Ruiz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 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
| | - Aaron D Goldberg
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James W Young
- 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; The Rockefeller University, 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
| | - Brian C Shaffer
- 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 M 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
| | - 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
| | - Miriam Sanchez Escamilla
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Hematological Malignancies and Stem Cell Transplantation, Research Institute Marqués de Valdecilla, Santander, Spain
| | - Nerea Castillo Flores
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 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
| | - 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
| | - Christina Cho
- 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
| | - Richard J Lin
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Molly A Maloy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ann A 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
| | - Ellin Berman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eytan M Stein
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Esperanza B 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
| | - 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
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, 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
| | - Melody Smith
- 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; Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Rodriguez N, Lee J, Flynn L, Murray F, Devlin SM, Soto C, Cho C, Dahi P, Giralt S, Perales MA, Sauter C, Ponce DM. Oral Proteasome Inhibitor Ixazomib for Switch-Maintenance Prophylaxis of Recurrent or Late Acute and Chronic Graft-versus-Host Disease after Day 100 in Allogeneic Stem Cell Transplantation. Transplant Cell Ther 2021; 27:920.e1-920.e9. [PMID: 34029766 DOI: 10.1016/j.jtct.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Graft-versus-host disease (GVHD) is a frequent complication in the first year after allogeneic stem cell transplantation (allo-HCT). Recipients of reduced-intensity (RI) or nonmyeloablative (NMA) conditioning combined with calcineurin inhibitor (CNI)-based GVHD prophylaxis frequently develop GVHD in the context of immunosuppression taper. Ixazomib is an oral proteasome inhibitor with a wide safety profile that has demonstrated immunomodulatory properties, inhibition of pro-inflammatory cytokines, and anti-tumor activity. We hypothesized that switch-maintenance GVHD prophylaxis using ixazomib would facilitate CNI taper without increased GVHD frequency and severity while maintaining graft-versus-tumor (GVT) effect and an acceptable safety profile. We conducted an open-label, prospective, single-center pilot study in patients with hematologic malignancies who received an RI or NMA conditioning and CNI-based GVHD prophylaxis that were within day 100 to 150 after HCT (n = 18). Patients were treated with ixazomib once weekly on a 28-day cycle (3 weeks on, 1 week off). Treatment was safe; most adverse events were grade 1 or 2, with cytopenia and elevation in transaminases the most common. Five patients were removed from the study because of toxicity or side effects. Only 5 of 18 patients developed GVHD during the study, and its severity was driven by acute manifestations while chronic involvement was mild. The cumulative incidence of grade II-IV acute and chronic GVHD at 1-year after HCT was 33% (95% confidence interval [CI], 13-55). No patients died during the study, and only 1 had malignant relapse. An additional patient relapsed after completion of the study but within 1 year after HCT. The probability of progression-free survival and GVHD-free/relapse-free survival (composite endpoint) at 1 year were 89% (95% CI, 75-100) and 78% (95% CI, 61-100), respectively. Immune reconstitution analysis showed a rapid and sustained recovery in T-cell subpopulations and B cell reconstitution, and vaccine response in a subset of patients demonstrated continuing or de novo positive protective antibody titers. This study demonstrated low incidence of recurrent and late acute and chronic GVHD within 1 year after HCT possible associated with switch-maintenance GVHD prophylaxis using ixazomib. This approach allowed for CNI taper while preserving GVT effect, without aggravating GVHD. Our findings support further development of this approach and provide a proof-of-concept for switch-maintenance GVHD prophylaxis.
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Affiliation(s)
- Natasia Rodriguez
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jasme Lee
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lisa Flynn
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fiona Murray
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cristina Soto
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christina Cho
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Parastoo Dahi
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Sergio Giralt
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Craig Sauter
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Doris M Ponce
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
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