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Bhatt NS, Meyer CL, Mau LW, Auletta JJ, Baker KS, Broglie L, Carpenter PA, Choi SW, Dandoy CE, Devine S, Phelan R. Return to school practices after hematopoietic cell transplantation: a survey of transplant centers in the United States. Bone Marrow Transplant 2024; 59:653-659. [PMID: 38378916 DOI: 10.1038/s41409-024-02239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
To understand transplant center recommendations on return-to-school timing and related support for hematopoietic cell transplant (HCT) survivors, we conducted a two-phase, cross-sectional, web-based survey: In Phase I, medical directors of pediatric HCT centers from the National Marrow Donor Program/ Be The Match Registry were asked regarding the availability of a return to school standardized operating procedure (SOP). In Phase II, HCT physician members of the Pediatric Transplantation and Cellular Therapy Consortium were approached to study inter-physician practice variability regarding return to school post-HCT, factors affecting their decision-making, and support provided by HCT centers for return to school. Out of 46 respondents in Phase I (55% response rate), 28 (61%) reported having a SOP. Wide variations in recommendations were noted in 12 received SOPs. In Phase II, 122 physicians (60 centers) responded (30.6% response rate). The majority (60%) recommended autologous HCT recipients return to school within 6 months post-HCT but 65% recommended allogeneic HCT recipients return to school after 6 months or once off immunosuppression. Our findings indicate a lack of consensus within and across HCT centers regarding recommended return to school timing and underscore need for a guideline to standardize this process to ensure patient safety and re-integration into school.
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Affiliation(s)
- Neel S Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Christa L Meyer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Lih-Wen Mau
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
- Tamkang University, Taipei, Taiwan
| | - Jeffery J Auletta
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Larisa Broglie
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI, USA
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Sung Won Choi
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, MN, USA
| | - Christopher E Dandoy
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Steven Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Rachel Phelan
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI, USA
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2
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Burhin M, Isom V, Ogaoga D, Devine S, Duke T, Bugoro H, Tamou M, Mark C, Panda N. Child health nursing in the Solomon Islands: A qualitative evaluation of the impact of the 'Bachelor of nursing - Child health'. Int Nurs Rev 2024; 71:35-43. [PMID: 36867657 DOI: 10.1111/inr.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/29/2023] [Indexed: 03/04/2023]
Abstract
AIM To explore graduates' perceptions of the impact on nursing practice of a new postgraduate course in child health, developed and implemented in the Solomon Islands in 2016. BACKGROUND The Bachelor of Nursing - Child Health was implemented in 2016 to develop nurses' knowledge and skills in child health and paediatric care with the intent to improve national child health outcomes. DESIGN A qualitative exploratory, descriptive design was used to evaluate the impact of the Bachelor of Nursing - Child Health on graduates' nursing practice. METHODS Fourteen nurses who graduated from the first cohort of students enrolled in the child health course were purposively selected to participate. Participants engaged in individual semi-structured interviews, conducted between August and December 2018. A thematic analysis was undertaken following Braun and Clarke's six-phase process. RESULTS Findings from the study demonstrate positive impacts of the course on graduates' nursing practice. These include a perceived enhanced quality of care through their commitment to evidence-based practice, the ability to contribute to capacity building of colleagues, the reinforcement of provincial public health programmes and expanded participation in managerial activities. Following graduation, most alumni took on senior roles and greater responsibilities, felt more confident in managing unwell children, felt there was better access to and quality of child health care at the community and broader country levels and felt recognised by colleagues and communities. Some graduates faced resistance from colleagues to change practice and felt that despite being given greater responsibilities, nursing levels and salaries remained unchanged. This reflected a potential lack of recognition from hospital or provincial managers, the Nursing Council as the regulatory body for the nursing profession, and the Ministry of Health and Medical Services. A lack of human and material resources also impacted quality of care. IMPLICATIONS FOR NURSING AND HEALTH POLICY Findings from this study underline the need for the Solomon Islands National University, the Nursing Council, the Public Service and the Ministry of Health and Medical Services to concord and delineate formal accreditation standards for child health nurses. Overall, collaborative efforts and commitments at local, regional and global levels are required to support child health nurses in their ability and ambition to improve national child health outcomes. CONCLUSIONS Findings from this study demonstrate positive impacts of the course on graduates' nursing practice. The impact of increasing nurses' knowledge and skills on national child health outcomes could be significant. Ongoing implementation and recognition of this course in the Solomon Islands, as well as more broadly across the Pacific region, are recommended.
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Affiliation(s)
- M Burhin
- Douglas Bebegu Yumba Campus, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Faculty of Nursing, Medicine and Health Sciences, Kukum Hwy, Solomon Islands National University, Honiara, Solomon Islands
- Centre for International Child Health, Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, 50, Flemington Rd, University of Melbourne, Parkville, Victoria, Australia
| | - V Isom
- Faculty of Nursing, Medicine and Health Sciences, Kukum Hwy, Solomon Islands National University, Honiara, Solomon Islands
| | - D Ogaoga
- Division of Reproductive, Maternal, Neonatal, Child and Adolescent Health, Old China Town, Kukum Highway, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - S Devine
- Douglas Bebegu Yumba Campus, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - T Duke
- Centre for International Child Health, Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, 50, Flemington Rd, University of Melbourne, Parkville, Victoria, Australia
| | - H Bugoro
- Faculty of Nursing, Medicine and Health Sciences, Kukum Hwy, Solomon Islands National University, Honiara, Solomon Islands
| | - M Tamou
- Division of Reproductive, Maternal, Neonatal, Child and Adolescent Health, Old China Town, Kukum Highway, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - C Mark
- Faculty of Nursing, Medicine and Health Sciences, Kukum Hwy, Solomon Islands National University, Honiara, Solomon Islands
| | - N Panda
- Faculty of Nursing, Medicine and Health Sciences, Kukum Hwy, Solomon Islands National University, Honiara, Solomon Islands
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Nakamura R, La Rosa C, Yang D, Hill JA, Rashidi A, Choe H, Zhou Q, Lingaraju CR, Kaltcheva T, Longmate J, Drake J, Slape C, Duarte L, Al Malki MM, Pullarkat VA, Aribi A, Devine S, Verneris MR, Miller JS, Forman SJ, Aldoss I, Diamond DJ. A phase II randomized, placebo-controlled, multicenter trial to evaluate the efficacy of cytomegalovirus PepVax vaccine in preventing cytomegalovirus reactivation and disease after allogeneic hematopoietic stem cell transplant. Haematologica 2024. [PMID: 38328852 DOI: 10.3324/haematol.2023.284544] [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] [Received: 11/07/2023] [Indexed: 02/09/2024] Open
Abstract
Not available.
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Affiliation(s)
| | - Corinna La Rosa
- Department of Hematology and Hematopoietic Cell Transplantation
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA
| | | | - Armin Rashidi
- Fred Hutchinson Cancer Center, Seattle, WA, USA; Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
| | - Hannah Choe
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Qiao Zhou
- Department of Hematology and Hematopoietic Cell Transplantation
| | | | | | - Jeffrey Longmate
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA
| | | | - Cynthia Slape
- Department of Clinical Research, City of Hope National Medical Center, Duarte, CA
| | - Lupe Duarte
- Department of Hematology and Hematopoietic Cell Transplantation
| | | | | | - Ahmed Aribi
- Department of Hematology and Hematopoietic Cell Transplantation
| | - Steven Devine
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Michael R Verneris
- University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Jeffrey S Miller
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
| | | | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation
| | - Don J Diamond
- Department of Hematology and Hematopoietic Cell Transplantation.
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Magenau J, Jaglowski S, Uberti J, Farag SS, Riwes MM, Pawarode A, Anand S, Ghosh M, Maciejewski J, Braun T, Devenport M, Lu S, Banerjee B, DaSilva C, Devine S, Zhang MJ, Burns LJ, Liu Y, Zheng P, Reddy P. A phase 2 trial of CD24Fc for prevention of graft-versus-host disease. Blood 2024; 143:21-31. [PMID: 37647633 PMCID: PMC10934299 DOI: 10.1182/blood.2023020250] [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: 02/27/2023] [Revised: 07/25/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023] Open
Abstract
ABSTRACT Patients who undergo human leukocyte antigen-matched unrelated donor (MUD) allogeneic hematopoietic stem cell transplantation (HSCT) with myeloablative conditioning for hematologic malignancies often develop acute graft-versus-host disease (GVHD) despite standard calcineurin inhibitor-based prophylaxis in combination with methotrexate. This trial evaluated a novel human CD24 fusion protein (CD24Fc/MK-7110) that selectively targets and mitigates inflammation due to damage-associated molecular patterns underlying acute GVHD while preserving protective immunity after myeloablative conditioning. This phase 2a, multicenter study evaluated the pharmacokinetics, safety, and efficacy of CD24Fc in combination with tacrolimus and methotrexate in preventing acute GVHD in adults undergoing MUD HSCT for hematologic malignancies. A double-blind, placebo-controlled, dose-escalation phase to identify a recommended dose was followed by an open-label expansion phase with matched controls to further evaluate the efficacy and safety of CD24Fc in preventing acute GVHD. A multidose regimen of CD24Fc produced sustained drug exposure with similar safety outcomes when compared with single-dose regimens. Grade 3 to 4 acute GVHD-free survival at day 180 was 96.2% (95% confidence interval [CI], 75.7-99.4) in the CD24Fc expansion cohort (CD24Fc multidose), compared with 73.6% (95% CI, 63.2-81.4) in matched controls (hazard ratio, 0.1 [95% CI, 0.0-0.6]; log-rank test, P = .03). No participants in the CD24Fc escalation or expansion phases experienced dose-limiting toxicities (DLTs). The multidose regimen of CD24Fc was well tolerated with no DLTs and was associated with high rates of severe acute GVHD-free survival after myeloablative MUD HSCT. This trial was registered at ClinicalTrials.gov as #NCT02663622.
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Affiliation(s)
- John Magenau
- Transplantation and Cellular Therapy Program, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Samantha Jaglowski
- The James Cancer Hospital and Solove Research Institute, Ohio State University, Columbus, OH
| | - Joseph Uberti
- Karmanos Cancer Center, Hudson-Webber Cancer Research Center, Detroit, MI
| | - Sherif S. Farag
- Blood and Bone Marrow Stem Cell Transplant and Immune Cell Therapy Program, Indiana University, Indianapolis, IN
| | - Mary Mansour Riwes
- Transplantation and Cellular Therapy Program, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Attaphol Pawarode
- Transplantation and Cellular Therapy Program, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Sarah Anand
- Transplantation and Cellular Therapy Program, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Monalisa Ghosh
- Transplantation and Cellular Therapy Program, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - John Maciejewski
- Transplantation and Cellular Therapy Program, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Thomas Braun
- Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI
| | - Linda J. Burns
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI
| | - Yang Liu
- OncoImmune, Inc, Rockville, MD
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD
| | - Pan Zheng
- OncoImmune, Inc, Rockville, MD
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD
| | - Pavan Reddy
- Transplantation and Cellular Therapy Program, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
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5
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Maziarz RT, Devine S, Garrison LP, Agodoa I, Badaracco J, Gitlin M, Perales MA. Estimating the Lifetime Medical Cost Burden of an Allogeneic Hematopoietic Cell Transplantation Patient. Transplant Cell Ther 2023; 29:637.e1-637.e9. [PMID: 37364775 PMCID: PMC11035010 DOI: 10.1016/j.jtct.2023.06.013] [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: 04/03/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) has the potential for curative outcomes for a variety of hematologic malignancies. Current allo-HCT studies often describe the outcomes and costs in the near term; however, research on the lifetime economic burden post-allo-HCT remains limited. This study was conducted to estimate the average total lifetime direct medical costs of an allo-HCT patient and the potential net monetary savings from an alternative treatment associated with improved graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS). A disease-state model was constructed using a short-term decision tree and a long-term semi-Markov partitioned survival model to estimate the average per-patient lifetime cost and expected quality-adjusted life years (QALYs) for an allo-HCT patient from a US healthcare system perspective. Key clinical inputs included overall survival, GRFS, incidence of both acute and chronic GVHD, relapse of the primary disease, and infections. Cost results were reported as ranges based on varying the percentage of chronic GVHD patients that remained on treatment after 2 years (15% or 39%). Over a lifetime, the average per-patient medical cost of allo-HCT was estimated to range from $942,373 to $1,247,917. The majority of the costs were for chronic GVHD treatment (37% to 53%), followed by the allo-HCT procedure (15% to 19%). The expected lifetime QALYs of an allo-HCT patient were estimated as 4.7. Lifetime per-patient treatment costs often exceed $1,000,000 for allo-HCT patients. Innovative research efforts focused on the reduction or elimination of late complications, particularly chronic GVHD, may provide the greatest value to improved patient outcomes.
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Affiliation(s)
- Richard T Maziarz
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
| | - Steven Devine
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington
| | | | | | | | - 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
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6
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Miller A, Davies J, Young K, Eckman E, Lo MY, Erskine H, Knutson L, Ondricek S, Margolis JM, Auletta JJ, Miller JP, Stefanski HE, Devine S, Pham HP. The effect of increased collect pump rate on collection efficiency in hematopoietic progenitor cell collection by apheresis in allogeneic adult donors-A single center analysis. Transfusion 2023; 63:1926-1936. [PMID: 37668194 DOI: 10.1111/trf.17533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Optimizing CD34 recovery while minimizing harm to hematopoietic progenitor cell donors by apheresis (HPC(A) donors) is critical to the success of allogeneic hematopoietic cell transplantation. We examined the efficacy and safety of starting allogeneic HPC(A) donors at a collect pump rate (CPR) of 2 mL/min on the Spectra Optia regardless of the inlet flow rate and/or pre-apheresis white blood cell (WBC) count (high CPR group). STUDY DESIGN AND METHODS A single-center retrospective study was performed on allogeneic adult donors from 10/2020 to 12/2022. From 10/2020 to 6/19/2022, all donors had CPR of ~1 mL/min (historical group). High CPR group started 6/20/2022. RESULTS During the study period, 412 donors were in historical group versus 196 (32.2%) in high CPR group. Median CD34 collection efficiency (CE) was higher and more consistent in high CPR group (55.1% vs. 53% in historical group, p < .0001) and remained significant in multivariate analysis. Although product volume was higher in high CPR group, WBC, hematocrit, and platelet concentrations were significantly lower. No difference in engraftment outcomes in patients receiving products from two groups was observed. Moreover, no differences occurred in a significant peri-procedural adverse event or percent decrease in platelets (6.87% decrease in platelets per 100 × 106 CD34 cells collected versus 6.66% in historical group, p = .89). Furthermore, high CPR group had ~26 min less in collection time for every 100 × 106 CD34 cells collected, resulting in less positive fluid balances. CONCLUSIONS Starting allogeneic HPC(A) donor collection at a CPR of 2 mL/min is safe and effective.
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Affiliation(s)
- Anthony Miller
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Jeramy Davies
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Kathryn Young
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Emily Eckman
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Melissa Y Lo
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Hannah Erskine
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Lisa Knutson
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Sara Ondricek
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Jamie M Margolis
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
| | | | - John P Miller
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
| | | | - Steven Devine
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
| | - Huy P Pham
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
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7
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Guru Murthy GS, Logan BR, Bo-Subait S, Beitinjaneh A, Devine S, Farhadfar N, Gowda L, Hashmi S, Lazarus H, Nathan S, Sharma A, Yared JA, Stefanski HE, Pulsipher MA, Hsu JW, Switzer GE, Panch SR, Shaw BE. Association of ABO mismatch with the outcomes of allogeneic hematopoietic cell transplantation for acute leukemia. Am J Hematol 2023; 98:608-619. [PMID: 36606713 PMCID: PMC10290878 DOI: 10.1002/ajh.26834] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/20/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). While many factors influence the outcomes of allo-HCT, the independent impact of donor-recipient ABO mismatching remains unclear. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we identified patients aged ≥18 years with AML or ALL who underwent allo-HCT between 2008 and 2018. Our objectives were to analyze the outcomes of allo-HCT based on the donor-recipient ABO status (match, minor mismatch, major mismatch, bidirectional mismatch). Among 4946 eligible patients, 2741 patients (55.4%) were ABO matched, 1030 patients (20.8%) had a minor ABO mismatch, 899 patients (18.1%) had a major ABO mismatch, and 276 patients (5.6%) had a bidirectional ABO mismatch. In multivariable analyses, compared to ABO matched allo-HCT, the presence of a major ABO mismatch was associated with worse overall survival (HR 1.16, 95% CI 1.05-1.29; p = 0.005), inferior platelet engraftment (HR 0.83, 95% CI 0.77-0.90; p < 0.001), and higher primary graft failure (HR 1.60, 95% CI 1.12-2.30, p = 0.01). Relapse, acute graft versus host disease (GVHD) grades III-IV and chronic GVHD were not significantly associated with ABO status. While donor age was not significantly associated with outcomes, older recipient age was associated with worse survival and non-relapse mortality. Our study demonstrates that donor-recipient ABO status is independently associated with survival and other post-transplantation outcomes in acute leukemia. This underscores the importance of considering the ABO status in donor selection algorithms and its impact in acute leukemia.
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Affiliation(s)
- Guru Subramanian Guru Murthy
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brent R Logan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephanie Bo-Subait
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota, USA
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Steven Devine
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota, USA
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Lohith Gowda
- Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut, USA
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Hillard Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jean A Yared
- Transplantation & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Heather E Stefanski
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota, USA
| | - Michael A Pulsipher
- Division of Hematology and Oncology, Intermountain Primary Children's Hospital, Huntsman Cancer Institute, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - Jack W Hsu
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Galen E Switzer
- Departments of Medicine, Psychiatry, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sandhya R Panch
- Fred Hutchinson Cancer Center/University of Washington, School of Medicine, Seattle, Washington, USA
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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8
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D’Souza A, Brazauskas R, Stadtmauer EA, Pasquini MC, Hari P, Bashey A, Callander N, Devine S, Efebera Y, Ganguly S, Gasparetto C, Geller N, Horowitz MM, Koreth J, Landau H, Brunstein C, McCarthy P, Qazilbash MH, Giralt S, Krishnan A, Flynn KE. Trajectories of quality of life recovery and symptom burden after autologous hematopoietic cell transplantation in multiple myeloma. Am J Hematol 2023; 98:140-147. [PMID: 35567778 PMCID: PMC9659666 DOI: 10.1002/ajh.26596] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
Early autologous hematopoietic cell transplantation (AHCT) with post-transplant maintenance therapy is standard of care in multiple myeloma (MM). While short-term quality of life (QOL) deterioration after AHCT is known, the long-term trajectories and symptom burden after transplantation are largely unknown. Toward this goal, a secondary analysis of QOL data of the BMT CTN 0702, a randomized controlled trial comparing outcomes of three treatment interventions after a single AHCT (N = 758), was conducted. FACT-BMT scores up to 4 years post-AHCT were analyzed. Symptom burden was studied using responses to 17 individual symptoms dichotomized as 'none/mild' for scores 0-2 and 'moderate/severe' for scores of 3 or 4. Patients with no moderate/severe symptom ratings were considered to have low symptom burden at 1-year. Mean age at enrollment was 55.5 years with 17% African Americans. Median follow-up was 6 years (range, 0.4-8.5 years). FACT-BMT scores improved between enrollment and 1-year and remained stable thereafter. Low symptom burden was reported by 27% of patients at baseline, 38% at 1-year, and 32% at 4 years post-AHCT. Predictors of low symptom burden at 1-year included low symptom burden at baseline: OR 2.7 (1.8-4.1), p < 0.0001; older age: OR 2.1 (1.3-3.2), p = 0.0007; and was related to being employed: OR 2.1 (1.4-3.2), p = 0.0004). We conclude that MM survivors who achieve disease control after AHCT have excellent recovery of FACT-BMT and subscale scores to population norms by 1-year post-transplant, though many patients continue to report moderate to severe severity in some symptoms at 1-year and beyond.
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Affiliation(s)
- Anita D’Souza
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ruta Brazauskas
- Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Edward A. Stadtmauer
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marcelo C. Pasquini
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Parameswaran Hari
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Asad Bashey
- Department of Hematology/Oncology, BMT Group of Georgia, Atlanta, Georgia, USA
| | - Natalie Callander
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Steven Devine
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yvonne Efebera
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Siddhartha Ganguly
- Department of Medicine, Kansas University Medical Center, Kansas City, Kansas, USA
| | | | - Nancy Geller
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Mary M. Horowitz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John Koreth
- Department of Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Heather Landau
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Claudio Brunstein
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philip McCarthy
- Department of Medicine, Roswell Park Cancer Center, Buffalo, New York, USA
| | - Muzaffar H. Qazilbash
- Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Amrita Krishnan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California, USA
| | - Kathryn E. Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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9
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Ding H, Li Y, Ang T, Liu Y, Devine S, Au R, Doraiswamy P, Liu C. Reproductive Markers in Alzheimer’s Disease Progression: The Framingham Heart Study. J Prev Alzheimers Dis 2023. [DOI: 10.14283/jpad.2023.28] [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: 03/18/2023]
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10
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Khandelwal P, Chaturvedi V, Owsley E, Efebera YA, Choe H, Bostic M, Kumchala P, Rajgolikar G, Ranganathan P, Garzon R, Lake K, Litts B, Duell A, Elder P, Davies SM, Lane A, Jordan MB, Vasu S, Devine S, Marsh RA. Prospective two center study of CD38 bright CD8+ effector memory T-cells as a predictor of acute GVHD. Transplantation Reports 2022. [DOI: 10.1016/j.tpr.2022.100100] [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] Open
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11
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Murdock HM, Kim HT, Denlinger N, Vachhani P, Hambley B, Manning BS, Gier S, Cho C, Tsai HK, McCurdy S, Ho VT, Koreth J, Soiffer RJ, Ritz J, Carroll MP, Vasu S, Perales MA, Wang ES, Gondek LP, Devine S, Alyea EP, Lindsley RC, Gibson CJ. Impact of diagnostic genetics on remission MRD and transplantation outcomes in older patients with AML. Blood 2022; 139:3546-3557. [PMID: 35286378 PMCID: PMC9203701 DOI: 10.1182/blood.2021014520] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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: 10/28/2021] [Accepted: 03/01/2022] [Indexed: 11/20/2022] Open
Abstract
Older patients with acute myeloid leukemia (AML) have high relapse risk and poor survival after allogeneic hematopoietic cell transplantation (HCT). Younger patients may receive myeloablative conditioning to mitigate relapse risk associated with high-risk genetics or measurable residual disease (MRD), but older adults typically receive reduced-intensity conditioning (RIC) to limit toxicity. To identify factors that drive HCT outcomes in older patients, we performed targeted mutational analysis (variant allele fraction ≥2%) on diagnostic samples from 295 patients with AML aged ≥60 years who underwent HCT in first complete remission, 91% of whom received RIC, and targeted duplex sequencing at remission in a subset comprising 192 patients. In a multivariable model for leukemia-free survival (LFS) including baseline genetic and clinical variables, we defined patients with low (3-year LFS, 85%), intermediate (55%), high (35%), and very high (7%) risk. Before HCT, 79.7% of patients had persistent baseline mutations, including 18.3% with only DNMT3A or TET2 (DT) mutations and 61.4% with other mutations (MRD positive). In univariable analysis, MRD positivity was associated with increased relapse and inferior LFS, compared with DT and MRD-negative mutations. However, in a multivariable model accounting for baseline risk, MRD positivity had no independent impact on LFS, most likely because of its significant association with diagnostic genetic characteristics, including MDS-associated gene mutations, TP53 mutations, and high-risk karyotype. In summary, molecular associations with MRD positivity and transplant outcomes in older patients with AML are driven primarily by baseline genetics, not by mutations present in remission. In this group of patients, where high-intensity conditioning carries substantial risk of toxicity, alternative approaches to mitigating MRD-associated relapse risk are needed.
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Affiliation(s)
- H Moses Murdock
- Division of Hematologic Neoplasia, Department of Medical Oncology, and
| | - Haesook T Kim
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Nathan Denlinger
- Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Pankit Vachhani
- Division of Hematology and Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Bryan Hambley
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Bryan S Manning
- Department of Medicine, Perelman Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Shannon Gier
- Department of Medicine, Perelman Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Christina Cho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Harrison K Tsai
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Shannon McCurdy
- Department of Medicine, Perelman Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Vincent T Ho
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - John Koreth
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Robert J Soiffer
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jerome Ritz
- Division of Hematologic Neoplasia, Department of Medical Oncology, and
| | - Martin P Carroll
- Department of Medicine, Perelman Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Sumithira Vasu
- Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, OH
| | | | - Eunice S Wang
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lukasz P Gondek
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | | | - Edwin P Alyea
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | | | - Christopher J Gibson
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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12
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Bhatt NS, Meyer C, Mau LW, Broglie L, Devine S, Choi SW, Auletta J, Phelan R. Return-to-School Practices for Pediatric Hematopoietic Cell Transplantation Recipients during the COVID-19 Pandemic. Transplant Cell Ther 2021; 28:54.e1-54.e4. [PMID: 34543770 PMCID: PMC8447546 DOI: 10.1016/j.jtct.2021.09.007] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 10/25/2022]
Abstract
Although organizations such as Centers for Disease Control and Prevention and American Academy of Pediatrics have published guidelines favoring the resumption of in-person schooling during the coronavirus disease 19 (COVID-19) pandemic, there is no specific guidance on hematopoietic cell transplantation (HCT) recipients' safe return to school. We conducted a cross-sectional survey of pediatric HCT physician members of the Pediatric Transplantation and Cellular Therapy Consortium practicing in the United States to describe current return-to-school practices during the COVID-19 pandemic for HCT recipients. A total of 122 respondents (response rate, 30.6%) from 60 transplant centers in 32 US states completed the survey. Most of the respondents (76%) recommended that HCT recipients consider a remote or hybrid school option at this time if possible. If not possible, the respondents recommended a return to in-person school if the patient is at least 12 months post-transplantation or off immune suppression, while taking school safety measures and local COVID-19 cases into account. These results provide valuable guidance for the HCT community, patients, and caregivers on important topics to consider while making return-to-school decisions.
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Affiliation(s)
- Neel S Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Christa Meyer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Lih-Wen Mau
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Larisa Broglie
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Steven Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Sung Won Choi
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Minnesota
| | - Jeffery Auletta
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Rachel Phelan
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
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13
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Ciurea SO, Kongtim P, Soebbing D, Trikha P, Behbehani G, Rondon G, Olson A, Bashir Q, Gulbis AM, Indreshpal K, Rezvani K, Shpall EJ, Bassett R, Cao K, Martin AS, Devine S, Horowitz M, Pasquini M, Lee DA, Champlin RE. Decrease post-transplant relapse using donor-derived expanded NK-cells. Leukemia 2021; 36:155-164. [PMID: 34312462 PMCID: PMC8727305 DOI: 10.1038/s41375-021-01349-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 01/12/2023]
Abstract
In this phase I/II clinical trial, we investigated the safety and efficacy of high doses of mb-IL21 ex vivo expanded donor-derived NK cells to decrease relapse in 25 patients with myeloid malignancies receiving haploidentical stem-cell transplantation (HSCT). Three doses of donor NK cells (1 × 105-1 × 108 cells/kg/dose) were administered on days -2, +7, and +28. Results were compared with an independent contemporaneously treated case-matched cohort of 160 patients from the CIBMTR database.After a median follow-up of 24 months, the 2-year relapse rate was 4% vs. 38% (p = 0.014), and disease-free survival (DFS) was 66% vs. 44% (p = 0.1) in the cases and controls, respectively. Only one relapse occurred in the study group, in a patient with the high level of donor-specific anti-HLA antibodies (DSA) presented before transplantation. The 2-year relapse and DFS in patients without DSA was 0% vs. 40% and 72% vs. 44%, respectively with HR for DFS in controls of 2.64 (p = 0.029). NK cells in recipient blood were increased at day +30 in a dose-dependent manner compared with historical controls, and had a proliferating, mature, highly cytotoxic, NKG2C+/KIR+ phenotype.Administration of donor-derived expanded NK cells after haploidentical transplantation was safe, associated with NK cell-dominant immune reconstitution early post-transplant, preserved T-cell reconstitution, and improved relapse and DFS. TRIAL REGISTRATION: NCT01904136 ( https://clinicaltrials.gov/ct2/show/NCT01904136 ).
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Affiliation(s)
- Stefan O Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Piyanuch Kongtim
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Doris Soebbing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Prashant Trikha
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gregory Behbehani
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amanda Olson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alison M Gulbis
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kaur Indreshpal
- GMP Laboratory, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,GMP Laboratory, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,GMP Laboratory, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kai Cao
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew St Martin
- Center for International Bone Marrow Transplant Research, Milwaukee, WI, USA
| | | | - Mary Horowitz
- Center for International Bone Marrow Transplant Research, Milwaukee, WI, USA
| | - Marcelo Pasquini
- Center for International Bone Marrow Transplant Research, Milwaukee, WI, USA
| | - Dean A Lee
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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Mock J, Meyer C, Mau LW, Nguyen C, Arora P, Heron C, Balkrishnan R, Burns L, Devine S, Ballen K. Barriers to Access to Hematopoietic Cell Transplantation among Patients with Acute Myeloid Leukemia in Virginia. Transplant Cell Ther 2021; 27:869.e1-869.e9. [PMID: 34224915 DOI: 10.1016/j.jtct.2021.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/02/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is a standard therapy for patients with intermediate to high-risk acute myeloid leukemia (AML) and is associated with improved long-term disease-free survival. Disparity exists in access to HCT among different patient populations and requires further study. In this study, we compared HCT rates for AML among different regions in the state of Virginia and identified geographic and socioeconomic factors associated with the likelihood of receiving HCT. We conducted a retrospective, cohort study of patients 18 to 74 years of age diagnosed with AML in Virginia from 2013 to 2017 as reported to the Virginia Cancer Registry (VCR); the VCR was further linked with the Center for International Blood and Marrow Transplant Research database for identification of patients who had undergone HCT within 2 years of diagnosis. Socioeconomic data were generated from the VCR and the American Community Survey. Univariate and multivariable logistic regression models were used to examine selected socioeconomic factors of interest, including patient-level information such as sex, age, race, marital status, and primary insurance payer, as well as factors associated with geography, including the Social Vulnerability Index (SVI) and percentage of African Americans residing in the region. In Virginia, 818 patients were diagnosed with AML from 2013 to 2017, and, of these, 168 patients (21%) underwent HCT within 2 years of diagnosis. Median age was lower in the HCT cohort (55 years) versus the non-HCT cohort (64 years) (P < .001). There was a higher proportion of married patients in the HCT cohort (67%) versus the non-HCT cohort (53%) (P = .005). The rate of HCT varied by geographic region (P = .004). The multivariable analyses (without including SVI) showed decreased likelihood of HCT with increasing age (odds ratio [OR], .96; 95% confidence interval [CI], .95 to .98). Patients from regions that had a greater than 25% African American population were less likely to undergo HCT (OR, .58; 95% CI, .38 to .89). Patients who were not married were less likely to undergo HCT compared with married patients (OR, .56; 95% CI, .36 to .88). Patients with government-sponsored insurance as the primary payer were less likely to undergo HCT compared with patients with private insurance (OR, .49; 95% CI, .32 to .77). Patients living in Zip Code areas with a greater percentage of population with a bachelor's or graduate degree were more likely to undergo HCT (OR, 1.02; 95% CI, 1.00 to 1.03). In a separate multivariate model with SVI, patients residing in a Zip Code with higher SVI were less likely to undergo HCT (OR, .37; 95% CI, .16 to .82). From 2013 to 2017, we found that the likelihood of a patient undergoing HCT in Virginia for AML within 2 years of diagnosis was negatively associated with increasing age, percent of African Americans residing in the region, not-married relationship status, government-sponsored insurance as primary payer, higher SVI, and decreased percent of population with a bachelor's or graduate degree. Resources should be directed toward at-risk patient populations to remove barriers to improve access to HCT. The SVI can be used to identify communities at risk nationwide.
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Affiliation(s)
- Joseph Mock
- Division of Hematology and Oncology, Department of Medicine, University of Virginia, Charlottesville, Virginia.
| | - Christa Meyer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Lih-Wen Mau
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Cecilia Nguyen
- Division of Hematology and Oncology, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Puja Arora
- UH Seidman Cancer Center, University Hospitals, Westlake, Ohio
| | - Courtney Heron
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rajesh Balkrishnan
- Cancer Population Health Core, UVA Cancer Center, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Linda Burns
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Steven Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Karen Ballen
- Division of Hematology and Oncology, Department of Medicine, University of Virginia, Charlottesville, Virginia
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15
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D'Souza A, Fretham C, Lee SJ, Arora M, Brunner J, Chhabra S, Devine S, Eapen M, Hamadani M, Hari P, Pasquini MC, Perez W, Phelan RA, Riches ML, Rizzo JD, Saber W, Shaw BE, Spellman SR, Steinert P, Weisdorf DJ, Horowitz MM. Corrigendum to ‘Current Use and Trends in Hematopoietic Cell Transplantation in the United States’ [Transplantation and Cellular Therapy 26/8 (2020) e177-e182]. Transplant Cell Ther 2021; 28:715-716. [DOI: 10.1016/j.jtct.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Mupfudze TG, Preussler JM, Sees JA, SanCartier M, Arnold SD, Devine S. A Qualitative Analysis of State Medicaid Coverage Benefits for Allogeneic Hematopoietic Cell Transplantation (alloHCT) for Patients with Sickle Cell Disease (SCD). Transplant Cell Ther 2021; 27:345-351. [PMID: 33836889 DOI: 10.1016/j.jtct.2021.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/05/2021] [Accepted: 01/24/2021] [Indexed: 11/28/2022]
Abstract
Sickle cell disease (SCD) is the most common inherited hemoglobin disorder, affecting approximately 100,000 people in the United States. Allogeneic hematopoietic cell transplantation (alloHCT), also known as bone marrow transplant (BMT), is currently the only established curative option for SCD. However, alloHCT is an optional benefit under Medicaid. This study of alloHCT coverage for patients with SCD aims to understand the scope of state Medicaid coverage benefits and BMT financial coordinators' experience working with their state Medicaid programs. States estimated to have more than 50 newborns diagnosed with SCD in 2016 and at least one active BMT Clinical Trials Network (1503 [STRIDE 2], NCT02766465) transplant center (TC) were eligible to participate in this study. Qualitative, semi-structured interviews 30 to 60 minutes in length were conducted with BMT financial coordinators via telephone between May and October 2019. A total of 10 BMT financial coordinators from 10 TCs representing eight states (Florida, Georgia, Illinois, Michigan, New York, Pennsylvania, Texas, and Virginia) participated in the semi-structured interviews. Coordinators in all of the included states reported that alloHCT in children with SCD with a human leukocyte antigen-matched sibling donor was covered by their state Medicaid programs. However, only two states (Florida and Texas) had legislative policies mandating coverage of routine medical costs for patients in clinical trials. TCs in two states (Illinois and Pennsylvania) reported accepting out-of-state Medicaid insurance, but only one state (Michigan) covered both travel and lodging for the patient and one caregiver. Four themes emerged when coordinators were asked about their perspectives and experiences working with their corresponding state Medicaid programs: (1) state Medicaid eligibility criteria based on disability were perceived as being restrictive, and Medicaid reimbursement rates were reported to be low; (2) Medicaid fee-for-service plans were perceived as being more comprehensive and easier to navigate compared to comprehensive managed care (CMC) plans; (3) there is a need to address caregiver and financial assistance beyond the health care costs; and (4) completing the insurance authorization process leading up to alloHCT is critical, including peer-to-peer reviews. There is limited legislative policy to help ensure access to clinical trials and provide out-of-state benefits and travel and lodging for Medicaid enrollees with SCD. These data provide insight into potential areas that could influence changes in policy to enhance access to curative therapy for SCD.
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Affiliation(s)
- Tatenda G Mupfudze
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, Georgia.
| | - Jaime M Preussler
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer A Sees
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, Georgia
| | - Michelle SanCartier
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, Georgia
| | - Staci D Arnold
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Emory University Hospital, Atlanta, Georgia
| | - Steven Devine
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, Georgia
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17
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Fuchs EJ, O'Donnell PV, Eapen M, Logan B, Antin JH, Dawson P, Devine S, Horowitz MM, Horwitz ME, Karanes C, Leifer E, Magenau JM, McGuirk JP, Morris LE, Rezvani AR, Jones RJ, Brunstein CG. Double unrelated umbilical cord blood vs HLA-haploidentical bone marrow transplantation: the BMT CTN 1101 trial. Blood 2021; 137:420-428. [PMID: 33475736 PMCID: PMC7819761 DOI: 10.1182/blood.2020007535] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [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: 06/16/2020] [Accepted: 08/16/2020] [Indexed: 12/11/2022] Open
Abstract
Results of 2 parallel phase 2 trials of transplantation of unrelated umbilical cord blood (UCB) or bone marrow (BM) from HLA-haploidentical relatives provided equipoise for direct comparison of these donor sources. Between June 2012 and June 2018, 368 patients aged 18 to 70 years with chemotherapy-sensitive lymphoma or acute leukemia in remission were randomly assigned to undergo UCB (n = 186) or haploidentical (n = 182) transplant. Reduced-intensity conditioning comprised total-body irradiation with cyclophosphamide and fludarabine for both donor types. Graft-versus-host disease prophylaxis for UCB transplantation was cyclosporine and mycophenolate mofetil (MMF) and for haploidentical transplantation, posttransplant cyclophosphamide, tacrolimus, and MMF. The primary end point was 2-year progression-free survival (PFS). Treatment groups had similar age, sex, self-reported ethnic origin, performance status, disease, and disease status at randomization. Two-year PFS was 35% (95% confidence interval [CI], 28% to 42%) compared with 41% (95% CI, 34% to 48%) after UCB and haploidentical transplants, respectively (P = .41). Prespecified analysis of secondary end points recorded higher 2-year nonrelapse mortality after UCB, 18% (95% CI, 13% to 24%), compared with haploidentical transplantation, 11% (95% CI, 6% to 16%), P = .04. This led to lower 2-year overall survival (OS) after UCB compared with haploidentical transplantation, 46% (95% CI, 38-53) and 57% (95% CI 49% to 64%), respectively (P = .04). The trial did not demonstrate a statistically significant difference in the primary end point, 2-year PFS, between the donor sources. Although both donor sources extend access to reduced-intensity transplantation, analyses of secondary end points, including OS, favor haploidentical BM donors. This trial was registered at www.clinicaltrials.gov as #NCT01597778.
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Affiliation(s)
- Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Paul V O'Donnell
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, and
| | - Brent Logan
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Joseph H Antin
- Department of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, and
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Chatchada Karanes
- Department of Hematology/Hematopoietic Cell Transplantation (HCT), City of Hope National Medical Center, Duarte, CA
| | - Eric Leifer
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - John M Magenau
- Michigan Medicine Bone Marrow Transplant and Leukemia, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Joseph P McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS
| | - Lawrence E Morris
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, GA
| | - Andrew R Rezvani
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University Medical Center, Stanford, CA; and
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Claudio G Brunstein
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
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18
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Dipersio J, Devine S, Hoggatt J, Scadden D, Howell H, Schmelmer V, Neale J, Boitano T, Cooke M, Morrow D, Raffel G, Savage W, Goncalves K, Falahee P, Davis J. FRI0235 PHASE 1 CLINICAL STUDY OF MGTA-145 IN COMBINATION WITH PLERIXAFOR SHOWS RAPID SINGLE-DAY MOBILISATION AND COLLECTION OF CD34+ HAEMATOPOIETIC STEM CELLS WITHOUT G-CSF. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Autologous haematopoietic stem cell (HSC) transplantation is a recommended therapeutic option for selected patients with autoimmune diseases. G-CSF mobilisation of HSCs requires 4-7 days of injections that are associated with significant side effects and potential for severe complications including disease flares (e.g., scleroderma and multiple sclerosis). MGTA-145 is a biologic that activates CXCR2 on neutrophils, and with plerixafor rapidly mobilises HSCs in mice and non-human primates. The combination promises to be a same-day, G-CSF-free mobilisation regimen.Objectives:To evaluate the safety, tolerability, and mobilisation efficacy of MGTA-145 monotherapy and combination therapy with plerixafor in healthy volunteers.Methods:This healthy volunteer phase 1 study consisted of 4 parts- Part A: single-agent MGTA-145 or placebo; Part B: MGTA-145 or placebo given immediately or 2 hours after plerixafor; Part C: MGTA-145 or placebo given 2 hours after plerixafor on 2 consecutive days; Part D: MGTA-145 given 2 hours after plerixafor, just prior to apheresis cell collection.Results:Monotherapy of MGTA-145 mobilised CD34+ cells within minutes and peaked within 1 hour post MGTA-145 (median 11 CD34+ cells/µL, a 7-fold increase vs baseline). White blood cells and neutrophils followed a similar pattern. Importantly, markers of neutrophil activation were relatively unchanged (≤2-fold vs baseline).MGTA-145 combined with plerixafor increased CD34+ cell mobilisation, whether given simultaneously or 2h after plerixafor (Fig. 1A). Mobilisation was highly enriched for CD34+CD90+CD45RA- HSCs, which tracked closely with the total CD34 count. At the 0.03 mg/kg dose with 2h stagger, median peak CD34+ peripheral blood mobilisation was ≥40 cells/µL in Part B. On a second consecutive day of dosing, MGTA-145 + plerixafor mobilises HSCs to levels comparable to day 1. Initial data from the ongoing Part D show that sufficient numbers of cells (median 4.3 x 10^6 CD34+ cells/kg) for transplant were collected in a single day.. Preliminary data from NSG mouse transplant studies of those mobilised HSCs in part D show higher engraftment rates of MGTA-145 + plerixafor mobilised HSCs, compared to G-CSF-mobilised HSCs.Figure.Peripheral blood mobilisation after plerixafor + 0.03 mg/kg MGTA-145 in healthy subjects with simultaneous and 2h stagger dosing after plerixafor. Dotted line: previously reported CD34+ counts with plerixafor alone mobilisation (Chenet al,Blood Advances. 2018).MGTA-145 monotherapy was well tolerated with no significant adverse events (AEs). Grade 1, transient lower back pain that dissipated within minutes was reported. The combination of MGTA-145 with plerixafor was well tolerated, with some subjects experiencing grade 1/2 gastrointestinal AEs commonly observed with plerixafor and one grade 2 back pain with MGTA-145 at 0.075 mg/kg that resolved within minutes.Conclusion:MGTA-145 monotherapy was well-tolerated and induced rapid mobilisation of significant numbers of HSCs. CD34+ cell mobilisation with MGTA-145 + plerixafor was immediate and superior to plerixafor alone. These data suggest that the combination can enable the collection of sufficient HSCs for transplant in one day without the need for G-CSF. Further development as a first line mobilisation product is warranted in autoimmune diseases, gene therapy and haematologic malignancies.Table.Single-day Mobilisation and Apheresis Cell Yields in Part DSubjectTotal CD34+ Yield (x106 cells)CD34+/kg (x106 cells)CD90+ (%)8013194.139%8073224.441%8175005.326%821 (*completed only 13L of planned 20L collection)2392.719%Median3214.333%Disclosure of Interests:John Dipersio Shareholder of: Magenta, Consultant of: Cellworks, Tioma, Rivervest, Bioline, Asterias, Amphivena and Bluebird, Celgene, Incyte, NeoImuneTech, Macrogenics, Steven Devine: None declared, Jonathan Hoggatt Shareholder of: Magenta, Grant/research support from: Magenta, Consultant of: Magenta, David Scadden Shareholder of: Magenta, Consultant of: Magenta, Haley Howell Shareholder of: Magenta, Employee of: Magenta, Veit Schmelmer Shareholder of: Magenta, Employee of: Magenta, Jason Neale Shareholder of: Magenta, Employee of: Magenta, Tony Boitano Shareholder of: Magenta, Employee of: Magenta, Michael Cooke Shareholder of: Magenta, Employee of: Magenta, Dwight Morrow Shareholder of: Magenta, Employee of: Magenta, Glen Raffel Shareholder of: Magenta, Employee of: Magenta, Will Savage Shareholder of: Magenta, Employee of: Magenta, Kevin Goncalves Shareholder of: Magenta, Employee of: Magenta, Pat Falahee Shareholder of: Magenta, Employee of: Magenta, John Davis Shareholder of: Magenta, Employee of: Magenta
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19
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D'Souza A, Fretham C, Lee SJ, Arora M, Brunner J, Chhabra S, Devine S, Eapen M, Hamadani M, Hari P, Pasquini MC, Perez W, Phelan RA, Riches ML, Rizzo JD, Saber W, Shaw BE, Spellman SR, Steinert P, Weisdorf DJ, Horowitz MM. Current Use of and Trends in Hematopoietic Cell Transplantation in the United States. Biol Blood Marrow Transplant 2020; 26:e177-e182. [PMID: 32438042 DOI: 10.1016/j.bbmt.2020.04.013] [Citation(s) in RCA: 299] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/23/2023]
Abstract
Hematopoietic cell transplantation (HCT) is a well-established treatment to control and/or cure many malignant and nonmalignant diseases involving the hematopoietic system and some solid tumors. We report information about HCT procedures performed in the United States in 2018 and analyze trends and outcomes of HCT as reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). Overall, compared with 2017, the number of allogeneic HCTs performed in the United States increased by 1%, and the number of autologous HCTs decreased by 5%. Key findings are fewer autologous HCTs performed for non-Hodgkin lymphoma and increasing numbers of haploidentical HCTs, nearly all of which use post-transplantation cyclophosphamide for graft-versus-host disease prophylaxis. There is a continuing increase in HCT in adults age >70 years, particularly for acute myelogenous leukemia and myelodysplastic syndromes. Survival rates by disease, disease stage, donor type, and age are presented. This report, prepared annually by the CIBMTR, provides a snapshot of current transplant activity in the United States.
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Affiliation(s)
- Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Caitrin Fretham
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; National Marrow Donor Program, Minneapolis, Minnesota
| | - Stephanie J Lee
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington
| | - Mukta Arora
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; University of Minnesota, Minneapolis, Minnesota
| | - Janet Brunner
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Steven Devine
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; National Marrow Donor Program, Minneapolis, Minnesota
| | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran Hari
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Waleska Perez
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Rachel A Phelan
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcie L Riches
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; University of North Carolina, Chapel Hill, North Carolina
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; National Marrow Donor Program, Minneapolis, Minnesota
| | - Patricia Steinert
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Daniel J Weisdorf
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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20
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Levine JE, Antin JH, Allen CE, Burroughs LM, Cooke KR, Devine S, Heslop H, Nakamura R, Talano JA, Yanik G, DiFronzo N. Priorities for Improving Outcomes for Nonmalignant Blood Diseases: A Report from the Blood and Marrow Transplant Clinical Trials Network. Biol Blood Marrow Transplant 2020; 26:e94-e100. [PMID: 32035274 DOI: 10.1016/j.bbmt.2020.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/24/2019] [Accepted: 01/28/2020] [Indexed: 01/19/2023]
Abstract
Nonmalignant blood diseases such as bone marrow failure disorders, immune dysregulation disorders, and hemoglobinopathies often lead to shortened life spans and poor quality of life. Many of these diseases can be cured with allogeneic hematopoietic cell transplantation, but patients are often not offered the procedure because of perceived insufficient efficacy and/or excess toxicity. In 2018, the Blood and Marrow Transplant Clinical Trials Network convened a task force to identify the most urgently needed yet feasible clinical trials with potential to improve the outcomes for patients with nonmalignant diseases. This report summarizes the task force discussions and specifies the network plans for clinical trial development for nonmalignant blood diseases.
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Affiliation(s)
- John E Levine
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Carl E Allen
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Lauri M Burroughs
- Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
| | - Kenneth R Cooke
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven Devine
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Helen Heslop
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | | | - Julie An Talano
- Department of Pediatric Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gregory Yanik
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nancy DiFronzo
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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21
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Kim HT, Ahn KW, Hu ZH, Davids MS, Volpe VO, Antin JH, Sorror ML, Shadman M, Press O, Pidala J, Hogan W, Negrin R, Devine S, Uberti J, Agura E, Nash R, Mehta J, McGuirk J, Forman S, Langston A, Giralt SA, Perales MA, Battiwalla M, Hale GA, Gale RP, Marks DI, Hamadani M, Ganguly S, Bacher U, Lazarus H, Reshef R, Hildebrandt GC, Inamoto Y, Cahn JY, Solh M, Kharfan-Dabaja MA, Ghosh N, Saad A, Aljurf M, Schouten HC, Hill BT, Pawarode A, Kindwall-Keller T, Saba N, Copelan EA, Nathan S, Beitinjaneh A, Savani BN, Cerny J, Grunwald MR, Yared J, Wirk BM, Nishihori T, Chhabra S, Olsson RF, Bashey A, Gergis U, Popat U, Sobecks R, Alyea E, Saber W, Brown JR. Prognostic Score and Cytogenetic Risk Classification for Chronic Lymphocytic Leukemia Patients: Center for International Blood and Marrow Transplant Research Report. Clin Cancer Res 2019; 25:5143-5155. [PMID: 31253630 DOI: 10.1158/1078-0432.ccr-18-3988] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/12/2018] [Revised: 03/06/2019] [Accepted: 05/08/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE To develop a prognostic model and cytogenetic risk classification for previously treated patients with chronic lymphocytic leukemia (CLL) undergoing reduced intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (HCT). EXPERIMENTAL DESIGN We performed a retrospective analysis of outcomes of 606 patients with CLL who underwent RIC allogeneic HCT between 2008 and 2014 reported to the Center for International Blood and Marrow Transplant Research. RESULTS On the basis of multivariable models, disease status, comorbidity index, lymphocyte count, and white blood cell count at HCT were selected for the development of prognostic model. Using the prognostic score, we stratified patients into low-, intermediate-, high-, and very-high-risk [4-year progression-free survival (PFS) 58%, 42%, 33%, and 25%, respectively, P < 0.0001; 4-year overall survival (OS) 70%, 57%, 54%, and 38%, respectively, P < 0.0001]. We also evaluated karyotypic abnormalities together with del(17p) and found that del(17p) or ≥5 abnormalities showed inferior PFS. Using a multivariable model, we classified cytogenetic risk into low, intermediate, and high (P < 0.0001). When the prognostic score and cytogenetic risk were combined, patients with low prognostic score and low cytogenetic risk had prolonged PFS (61% at 4 years) and OS (75% at 4 years). CONCLUSIONS In this large cohort of patients with previously treated CLL who underwent RIC HCT, we developed a robust prognostic scoring system of HCT outcomes and a novel cytogenetic-based risk stratification system. These prognostic models can be used for counseling patients, comparing data across studies, and providing a benchmark for future interventions. For future study, we will further validate these models for patients receiving targeted therapies prior to HCT.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers
- Chromosome Aberrations
- Comorbidity
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukocyte Count
- Male
- Middle Aged
- Prognosis
- Risk Assessment
- Survival Analysis
- Transplantation Conditioning
- Transplantation, Homologous
- Young Adult
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Affiliation(s)
- Haesook T Kim
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, and Harvard School of Public Health, Boston, Massachusetts.
| | - Kwang Woo Ahn
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhen-Huan Hu
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew S Davids
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Virginia O Volpe
- Department of Internal Medicine, Division of Oncology's Neag Cancer Center, University of Connecticut Health Center, Farmington, Connecticut
| | - Joseph H Antin
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Oliver Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - William Hogan
- Departments of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, Minnesota
| | | | - Steven Devine
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | | | | | | | | | | | | | - Amelia Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Sergio A Giralt
- 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
| | - Minoo Battiwalla
- Hematology Branch, Sarah Cannon BMT Program, Nashville, Tennessee
| | - Gregory A Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Mehdi Hamadani
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sid Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, Bern, Switzerland
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Ran Reshef
- Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | | | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, the Netherlands
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia
| | - Nakhle Saba
- Tulane University Medical Center, New Orleans, Louisiana
| | - Edward A Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | | | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jan Cerny
- UMASS Memorial Medical Center, Worcester, Massachusetts
| | - Michael R Grunwald
- Carolinas Medical Center Blumenthal Cancer Center Stem Cell Transplant Program, Levine Cancer Institute, Charlotte, North Carolina
| | - Jean Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Uday Popat
- MD Anderson Cancer Center, Houston, Texas
| | | | - Edwin Alyea
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Wael Saber
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Jennifer R Brown
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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22
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Stadtmauer EA, Pasquini MC, Blackwell B, Hari P, Bashey A, Devine S, Efebera Y, Ganguly S, Gasparetto C, Geller N, Horowitz MM, Koreth J, Knust K, Landau H, Brunstein C, McCarthy P, Nelson C, Qazilbash MH, Shah N, Vesole DH, Vij R, Vogl DT, Giralt S, Somlo G, Krishnan A. Autologous Transplantation, Consolidation, and Maintenance Therapy in Multiple Myeloma: Results of the BMT CTN 0702 Trial. J Clin Oncol 2019; 37:589-597. [PMID: 30653422 PMCID: PMC6553842 DOI: 10.1200/jco.18.00685] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Single-cycle melphalan 200 mg/m2 and autologous hematopoietic cell transplantation (AHCT) followed by lenalidomide (len) maintenance have improved progression-free survival (PFS) and overall survival (OS) for transplantation-eligible patients with multiple myeloma (MM). We designed a prospective, randomized, phase III study to test additional interventions to improve PFS by comparing AHCT, tandem AHCT (AHCT/AHCT), and AHCT and four subsequent cycles of len, bortezomib, and dexamethasone (RVD; AHCT + RVD), all followed by len until disease progression. PATIENTS AND METHODS Patients with symptomatic MM within 12 months from starting therapy and without progression who were age 70 years or younger were randomly assigned to AHCT/AHCT + len (n = 247), AHCT + RVD + len (n = 254), or AHCT + len (n = 257). The primary end point was 38-month PFS. RESULTS The study population had a median age of 56 years (range, 20 to 70 years); 24% of patients had high-risk MM, 73% had a triple-drug regimen as initial therapy, and 18% were in complete response at enrollment. The 38-month PFS rate was 58.5% (95% CI, 51.7% to 64.6%) for AHCT/AHCT + len, 57.8% (95% CI, 51.4% to 63.7%) for AHCT + RVD + len, and 53.9% (95% CI, 47.4% to 60%) for AHCT + len. For AHCT/AHCT + len, AHCT + RVD + len, and AHCT + len, the OS rates were 81.8% (95% CI, 76.2% to 86.2%), 85.4% (95% CI, 80.4% to 89.3%), and 83.7% (95% CI, 78.4% to 87.8%), respectively, and the complete response rates at 1 year were 50.5% (n = 192), 58.4% (n = 209), and 47.1% (n = 208), respectively. Toxicity profiles and development of second primary malignancies were similar across treatment arms. CONCLUSION Second AHCT or RVD consolidation as post-AHCT interventions for the up-front treatment of transplantation-eligible patients with MM did not improve PFS or OS. Single AHCT and len should remain as the standard approach for this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nancy Geller
- 8 National Heart, Lung, and Blood Institute, Rockville, MD
| | | | | | | | | | | | | | | | | | - Nina Shah
- 14 University of California, San Francisco, San Francisco, CA
| | | | - Ravi Vij
- 16 Washington University, St Louis, MO
| | - Dan T Vogl
- 1 University of Pennsylvania, Philadelphia, PA
| | - Sergio Giralt
- 10 Memorial Sloan Kettering Cancer Center, New York, NY
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23
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Repaczki-Jones R, Hrnicek AK, Heissenbuttel A, Devine S, Fernandez H, Anasetti C. Defining Competency to Empower Blood and Marrow Transplant and Cellular Immunotherapy Quality Management Professionals in Healthcare. Biol Blood Marrow Transplant 2019; 25:179-182. [DOI: 10.1016/j.bbmt.2018.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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24
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Hassan M, Ulezko Antonova A, Li JM, Hosoba S, Rupji M, Kowalski J, Perricone AJ, Jaye DL, Marsh H, Yellin M, Devine S, Waller EK. Flt3L Treatment of Bone Marrow Donors Increases Graft Plasmacytoid Dendritic Cell Content and Improves Allogeneic Transplantation Outcomes. Biol Blood Marrow Transplant 2018; 25:1075-1084. [PMID: 30503387 PMCID: PMC10373795 DOI: 10.1016/j.bbmt.2018.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/26/2018] [Indexed: 12/24/2022]
Abstract
A higher number of donor plasmacytoid dendritic cells (pDCs) is associated with increased survival and reduced graft-versus-host disease (GVHD) in human recipients of unrelated donor bone marrow (BM) grafts, but not granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood grafts. We show that in murine models, donor BM pDCs are associated with increased survival and decreased GVHD compared with G-CSF-mobilized pDCs. To increase the content of pDCs in BM grafts, we studied the effect of FMS-like tyrosine kinase 3 ligand (Flt3L) treatment of murine BM donors on transplantation outcomes. Flt3L treatment (300 μg/kg/day) resulted in a schedule-dependent increase in the content of pDCs in the BM. Mice treated on days -4 and -1 had a >5-fold increase in pDC content without significant changes in numbers of HSCs, T cells, B cells, and natural killer cells in the BM graft. In an MHC-mismatched murine transplant model, recipients of Flt3L-treated T cell-depleted (TCD) BM (TCD F-BM) and cytokine-untreated T cells had increased survival and decreased GVHD scores with fewer Th1 and Th17 polarized T cells post-transplantation compared with recipients of equivalent numbers of untreated donor TCD BM and T cells. Gene array analyses of pDCs from Flt3L-treated human and murine donors showed up-regulation of adaptive immune pathways and immunoregulatory checkpoints compared with pDCs from untreated BM donors. Transplantation of TCD F-BM plus T cells resulted in no loss of the graft-versus-leukemia (GVL) effect compared with grafts from untreated donors in 2 murine GVL models. Thus, Flt3L treatment of BM donors is a novel method for increasing the pDC content in allografts, improving survival, and decreasing GVHD without diminishing the GVL effect.
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Affiliation(s)
- Mojibade Hassan
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Alina Ulezko Antonova
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Jian Ming Li
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Sakura Hosoba
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Manali Rupji
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Jeanne Kowalski
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Adam J Perricone
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | - David L Jaye
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | | | | | - Steven Devine
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia.
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25
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Vaughn JL, Zhao Q, Epperla N, Puto M, Roddy J, Elder P, Blum W, Klisovic R, Jaglowski S, Penza S, William B, Andritsos L, Brammer JE, Hofmeister C, Efebera Y, Benson D, Devine S, Cataland S, Vasu S. Transplant-associated thrombotic microangiopathy: is the treatment more expensive than the disease? Bone Marrow Transplant 2018; 54:913-916. [DOI: 10.1038/s41409-018-0390-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 01/31/2023]
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26
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Welliver M, Vasu S, Weldon M, Zoller W, Addington M, Eiler D, Jacob N, Denko N, Martin D, Gupta N, Liu A, Rong Y, Wong J, White J, Devine S. Utilizing Organ-Sparing Marrow-Targeted Irradiation (OSMI) to Condition Patients with High-risk Hematologic Malignancies Prior to Allogeneic Hematopoietic Stem Cell Transplantation: Results from a Prospective Pilot Study. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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McFarlane K, Judd J, Devine S, Watt K. Reorientation of health services: enablers and barriers faced by organisations when increasing health promotion capacity. Health Promot J Austr 2018; 27:118-133. [PMID: 27094432 DOI: 10.1071/he15078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/07/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed Primary healthcare settings are important providers of health promotion approaches. However, organisational challenges can affect their capacity to deliver these approaches. This review identified the common enablers and barriers health organisations faced and it aimed to explore the experiences health organisations, in particular Aboriginal organisations, had when increasing their health promotion capacity. Methods A systematic search of peer-reviewed literature was conducted. Articles published between 1990-2014 that focused on a health care-settings approach and discussed factors that facilitated or hindered an organisation's ability to increase health promotion capacity were included. Results Twenty-five articles met the inclusion criteria. Qualitative (n=18) and quantitative (n=7) study designs were included. Only one article described the experiences of an Aboriginal health organisation. Enablers included: management support, skilled staff, provision of external support to the organisation, committed staffing and financial resources, leadership and the availability of external partners to work with. Barriers included: lack of management support, lack of dedicated health promotion staff, staff lacking skills or confidence, competing priorities and a lack of time and resources allocated to health promotion activities. Conclusions While the literature highlighted the importance of health promotion work, barriers can limit the delivery of health promotion approaches within primary healthcare organisations. A gap in the literature exists about how Aboriginal health organisations face these challenges. So what? Primary healthcare organisations wanting to increase their health promotion capacity can pre-empt the common barriers and strengthen identified enablers through the shared learnings outlined in this review.
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Affiliation(s)
- K McFarlane
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia
| | - J Judd
- Division of Tropical Health and Medicine, James Cook University, Townsville, Qld 4811, Australia
| | - S Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia
| | - K Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia
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28
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Weisdorf D, Cooley S, Wang T, Trachtenberg E, Haagenson MD, Vierra-Green C, Spellman S, Spahn A, Vogel J, Kobusingye H, Fehninger T, Woolfrey A, Devine S, Ross M, Waller EK, Sobecks R, Parham P, Guethlein LA, Marsh SGE, Miller J. KIR Donor Selection: Feasibility in Identifying better Donors. Biol Blood Marrow Transplant 2018; 25:e28-e32. [PMID: 30149149 DOI: 10.1016/j.bbmt.2018.08.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/18/2018] [Indexed: 01/17/2023]
Abstract
We previously reported that acute myelogenous leukemia (AML) transplants using killer cell immunoglobulin-type receptor (KIR) B haplotype better or best (≥2 B activating gene loci ± Cen B/B) unrelated donors (URDs) yield less relapse and better survival. In this prospective trial we evaluated 535 AML searches from 14 participating centers with centralized donor KIR genotyping for donor selection. This represented 3% to 48% of all AML searches (median 20%) per center, totaling 3 to 172 patients (median 22) per center. Donor KIR genotype was reported at a median of 14 days after request (≤26 days for 76% of searches). In 535 searches, 2080 donors were requested for KIR genotyping (mean 4.3 per search); and a median of 1.8 (range, 0 to 4.5) per search were KIR typed. Choosing more donors for confirmatory HLA and KIR haplotype identification enriched the likelihood of finding KIR better or best donors. The search process identified a mean of 30% KIR better or best donors; the success ranged from 24% to 38% in the 11 centers enrolling ≥8 patients. More donors requested for KIR genotyping increased the likelihood of identifying KIR better or best haplotype donors. Of the 247 transplants, 9.3% used KIR best, 19% used KIR better, and 48% used KIR neutral donors while 24% used a non-KIR-tested donor. KIR genotyping did not delay transplantation. The time from search to transplant was identical for transplants using a KIR-genotyped versus a non-KIR-genotyped donor. Prospective evaluation can rapidly identify KIR favorable genotype donors, but choosing more donors per search would substantially increase the likelihood of having a KIR best or better donor available for transplantation. Transplant centers and donor registries must both commit extra effort to incorporate new characteristics (beyond HLA, age, and parity) into improved donor selection. Deliberate efforts to present additional genetic factors for donor selection will require novel procedures.
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Affiliation(s)
- Daniel Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
| | - Sarah Cooley
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Tao Wang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Michael D Haagenson
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI & Minneapolis, MN
| | - Cynthia Vierra-Green
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI & Minneapolis, MN
| | - Stephen Spellman
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI & Minneapolis, MN
| | - Ashley Spahn
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI & Minneapolis, MN
| | - Jenny Vogel
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI & Minneapolis, MN
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI & Minneapolis, MN
| | | | - Ann Woolfrey
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | | | - Steven G E Marsh
- Anthony Nolan Research Institute and UCL Cancer Institute, Royal Free Campus, London, United Kingdom
| | - Jeffrey Miller
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
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29
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Hartwell MJ, Özbek U, Holler E, Renteria AS, Major-Monfried H, Reddy P, Aziz M, Hogan WJ, Ayuk F, Efebera YA, Hexner EO, Bunworasate U, Qayed M, Ordemann R, Wölfl M, Mielke S, Pawarode A, Chen YB, Devine S, Harris AC, Jagasia M, Kitko CL, Litzow MR, Kröger N, Locatelli F, Morales G, Nakamura R, Reshef R, Rösler W, Weber D, Wudhikarn K, Yanik GA, Levine JE, Ferrara JL. An early-biomarker algorithm predicts lethal graft-versus-host disease and survival. JCI Insight 2018; 3:124015. [PMID: 30135313 DOI: 10.1172/jci.insight.124015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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30
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Rosko AE, Huang Y, Benson DM, Efebera YA, Hofmeister C, Jaglowski S, Devine S, Bhatt G, Wildes TM, Dyko A, Jones D, Naughton MJ, Byrd JC, Burd CE. Use of a comprehensive frailty assessment to predict morbidity in patients with multiple myeloma undergoing transplant. J Geriatr Oncol 2018; 10:479-485. [PMID: 29983352 DOI: 10.1016/j.jgo.2018.05.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 04/26/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
Abstract
Multiple myeloma (MM) is a disease of aging adults and autologous stem cell transplant (ASCT) is considered the standard of care. As the population ages a growing number of older adults will undergo ASCT and an objective approach to estimate physiologic reserve and transplant morbidity risk is warranted. Here, we evaluate assess p16INK4a (p16), a molecular aging biomarker, along with geriatric metrics to determine risk of transplant toxicity. METHODS We prospectively evaluated 100 MM patients for frailty before and after ASCT using a Geriatric Assessment (GA) and collected T-cells for analysis of p16 using a custom nanostring codeset. RESULTS Pre-transplant physical function was predicative of hospital length of stay (LOS). Each one-unit increase in physical function score, the average LOS decreased by 0.52 days (95% CI, -1.03-0.02); p = .04). Similarly, higher self-report of ADL/IADL (Human Activity Profile was associated with shorter LOS (0.65 less days (95% CI -1.15 to -0.15), p = .01). Patients with anxiety/depression (OR = 1.10 (95% CI 1.00-1.22), p = .056), lower handgrip strength (OR = 0.90 (95% CI 0.82-0.98), p = .02), falls (OR = 1.60 (95% CI 1.07-2.38), p = .02), or weight loss (OR = 5.65 (95% CI 1.17-25.24), p = .03) were more likely to be re-admitted. The estimated EFS at 1-year was 85% (95% CI, 75-91) with median follow-up of 15.7 months. Weight loss was a significant predictor of EFS (HR = 3.13 (95% CI 1.15-8.50), p = .03). Frailty assessment by self-reported fatigue minimally correlated with T-cell p16 expression (r = 0.28; p = .02). Age, Karnofsky Performance Status (KPS), or Hematopoietic cell transplantation-specific Co-Morbidity Index (HCT-CI) did not predict hospital LOS or readmissions. CONCLUSIONS Our data illustrate that a GA can identify individuals with MM who are at greater risk for morbidity following ASCT.
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Affiliation(s)
- Ashley E Rosko
- Division of Hematology, The Ohio State University, Columbus, OH, United States.
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | - Don M Benson
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | - Yvonne A Efebera
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | - Craig Hofmeister
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Samantha Jaglowski
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | - Steven Devine
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | - Geetika Bhatt
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | - Tanya M Wildes
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Alanna Dyko
- Division of Medicinal Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, United States
| | - Desirée Jones
- Division of Hematology, The Ohio State University, Columbus, OH, United States
| | - Michelle J Naughton
- Cancer Prevention and Control, The Ohio State University, Columbus, OH, United States
| | - John C Byrd
- Division of Hematology, The Ohio State University, Columbus, OH, United States; Division of Medicinal Chemistry, College of Pharmacy, The Ohio State University, Columbus, OH, United States
| | - Christin E Burd
- Departments of Molecular Genetics and Cancer Biology and Genetics, The Ohio State University, Columbus, OH, United States
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31
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Rashidi A, Linden MA, Percival ME, Sandmaier BM, Devine S, Weisdorf DJ. Recommendations for reporting post-transplant relapse in AML. Bone Marrow Transplant 2017; 53:111-113. [PMID: 29084204 DOI: 10.1038/bmt.2017.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 01/28/2023]
Affiliation(s)
- A Rashidi
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - M A Linden
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - M-E Percival
- Clinical Research Division, Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, WA, USA
| | - B M Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, WA, USA
| | - S Devine
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | - D J Weisdorf
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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32
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Wall SA, Devine S, Vasu S. The who, how and why: Allogeneic transplant for acute myeloid leukemia in patients older than 60years. Blood Rev 2017; 31:362-369. [PMID: 28802907 DOI: 10.1016/j.blre.2017.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/26/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
Acute myelogenous leukemia (AML) is primarily a disease of the elderly, and as such, our approach to treatment needs to be tailored to address an aging population. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only potentially curative treatment for intermediate and high risk AML, and until recently, its use had been limited to a younger population and dependent on availability of a donor. Advances in conditioning regimens, supportive care, and the use of alternative donor sources have greatly expanded access to this therapy. In this review, we summarize the challenges and unique biological aspects of treatment with allogeneic stem cell transplantation in this group of patients older than 60years. We also highlight areas of ongoing research including measurement of residual disease prior to and following transplant, post-remission maintenance therapy, and natural killer cell immunotherapy. Finally, we propose future directions for AML treatment in an elderly and aging population.
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Affiliation(s)
- Sarah A Wall
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | - Steven Devine
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | - Sumithira Vasu
- Division of Hematology, Ohio State University, Columbus, OH, USA.
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33
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Ustun C, DeFor TE, Rashidi A, Devine S, Miller J, Weisdorf D. Time-to-Event Ratio to Predict Outcome in Patients with Acute Myeloid Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation? Biol Blood Marrow Transplant 2017; 23:1804-1808. [PMID: 28688918 DOI: 10.1016/j.bbmt.2017.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Celalettin Ustun
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Todd E DeFor
- Biostatistics and Bioinformatics, University of Minnesota, Minneapolis, Minnesota
| | - Armin Rashidi
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Steven Devine
- Division of Hematology, Ohio State University, Columbus, Ohio
| | - Jeffrey Miller
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Weisdorf
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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34
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Sborov DW, Cho YK, Cottini F, Hade EM, Lamprecht M, Tackett K, Sharma N, Williams N, Li J, Devine S, Poi M, Phelps MA, Hofmeister CC. G-CSF improves safety when you start the day after autologous transplant in multiple myeloma. Leuk Lymphoma 2017; 58:2947-2951. [PMID: 28509594 DOI: 10.1080/10428194.2017.1318436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Douglas W Sborov
- a Division of Hematology, Department of Internal Medicine, College of Medicine, t he Ohio State University , Columbus , OH , USA
| | - Yu Kyoung Cho
- b Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy , the Ohio State University , Columbus , OH , USA
| | - Francesca Cottini
- c Internal Medicine Residency Program, Department of Internal Medicine, College of Medicine , the Ohio State University , Columbus , OH , USA
| | - Erinn M Hade
- d Center for Biostatistics, Department of Biomedical Informatics , the Ohio State University , Columbus , OH , USA
| | - Misty Lamprecht
- e Ohio State University Wexner Medical Center, the Ohio State University , Columbus , OH , USA
| | - Karen Tackett
- e Ohio State University Wexner Medical Center, the Ohio State University , Columbus , OH , USA
| | - Nidhi Sharma
- a Division of Hematology, Department of Internal Medicine, College of Medicine, t he Ohio State University , Columbus , OH , USA
| | - Nita Williams
- a Division of Hematology, Department of Internal Medicine, College of Medicine, t he Ohio State University , Columbus , OH , USA
| | - Junan Li
- b Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy , the Ohio State University , Columbus , OH , USA
| | - Steven Devine
- a Division of Hematology, Department of Internal Medicine, College of Medicine, t he Ohio State University , Columbus , OH , USA
| | - Ming Poi
- b Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy , the Ohio State University , Columbus , OH , USA.,f Division of Pharmacy Practice and Administration, College of Pharmacy , the Ohio State University , Columbus , OH , USA
| | - Mitch A Phelps
- b Division of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy , the Ohio State University , Columbus , OH , USA
| | - Craig C Hofmeister
- a Division of Hematology, Department of Internal Medicine, College of Medicine, t he Ohio State University , Columbus , OH , USA
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35
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Hamilton BK, Rybicki L, Abounader D, Adekola K, Advani A, Aldoss I, Bachanova V, Bashey A, Brown S, DeLima M, Devine S, Flowers CR, Ganguly S, Jagasia M, Kennedy VE, Kim DDH, McGuirk J, Pullarkat V, Romee R, Sandhu K, Smith M, Ueda M, Viswabandya A, Vu K, Wall S, Zeichner SB, Perales MA, Majhail NS. Allogeneic Hematopoietic Cell Transplantation for Adult T Cell Acute Lymphoblastic Leukemia. Biol Blood Marrow Transplant 2017; 23:1117-1121. [PMID: 28396160 DOI: 10.1016/j.bbmt.2017.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 01/17/2017] [Accepted: 04/05/2017] [Indexed: 12/12/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is recommended for patients with T cell acute lymphoblastic leukemia (T-ALL) in second or later complete remission (CR) and high-risk patients in first CR. Given its relative rarity, data on outcomes of HCT for T-ALL are limited. We conducted a multicenter retrospective cohort study using data from 208 adult patients who underwent HCT between 2000 and 2014 to describe outcomes of allogeneic HCT for T-ALL in the contemporary era. The median age at HCT was 37 years, and the majority of patients underwent HCT in CR, using total body irradiation (TBI)-based myeloablative conditioning regimens. One-quarter of the patients underwent alternative donor HCT using a mismatched, umbilical cord blood, or haploidentical donor. With a median follow up of 38 months, overall survival at 5 years was 34%. The corresponding cumulative incidence of non-relapse mortality and relapse was 26% and 41%, respectively. In multivariable analysis, factors significantly associated with overall survival were the use of TBI (HR, 0.57; P = .021), age >35 years (HR, 1.55; P = .025), and disease status at HCT (HR, 1.98; P = .005 for relapsed/refractory disease compared with CR). Relapse was the most common cause of death (58% of patients). Allogeneic HCT remains a potentially curative option in selected patients with adult T-ALL, although relapse is a major cause of treatment failure.
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Affiliation(s)
- Betty Ky Hamilton
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
| | - Lisa Rybicki
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Donna Abounader
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Kehinde Adekola
- Division of Hematology/Medical Oncology, Northwestern University, Chicago, Illinois
| | - Anjali Advani
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California
| | - Veronika Bachanova
- Department of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Asad Bashey
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Stacey Brown
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Marcos DeLima
- Department of Medicine, Seidman Cancer Center, University Hospitals of Cleveland, Cleveland, Ohio
| | - Steven Devine
- Blood and Marrow Transplant Program, Ohio State University, Columbus, Ohio
| | | | - Siddharth Ganguly
- Division of Hematologic Malignancies and Cellular Therapy, University of Kansas, Kansas City, Kansas
| | - Madan Jagasia
- Division of Hematology-Oncology, Vanderbilt University, Nashville, Tennessee
| | - Vanessa E Kennedy
- Division of Hematology-Oncology, Vanderbilt University, Nashville, Tennessee
| | - Dennis Dong Hwan Kim
- Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapy, University of Kansas, Kansas City, Kansas
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California
| | - Rizwan Romee
- Bone Marrow Transplant and Leukemia Program, Washington University in St Louis, St Louis, Missouri
| | - Karamjeet Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California
| | - Melody Smith
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Adult Bone Marrow Transplant Service, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Masumi Ueda
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Auro Viswabandya
- Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Khoan Vu
- Bone Marrow Transplant and Leukemia Program, Washington University in St Louis, St Louis, Missouri
| | - Sarah Wall
- Blood and Marrow Transplant Program, Ohio State University, Columbus, Ohio
| | - Simon B Zeichner
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Adult Bone Marrow Transplant Service, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
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Vela CM, Grate LM, McBride A, Devine S, Andritsos LA. A retrospective review of fall risk factors in the bone marrow transplant inpatient service. J Oncol Pharm Pract 2017; 24:272-280. [PMID: 29284362 DOI: 10.1177/1078155217697485] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study was to compare medications and potential risk factors between patients who experienced a fall during hospitalization compared to those who did not fall while admitted to the Blood and Marrow Transplant inpatient setting at The James Cancer Hospital. Secondary objectives included evaluation of transplant-related disease states and medications in the post-transplant setting that may lead to an increased risk of falls, post-fall variables, and number of tests ordered after a fall. Methods This retrospective, case-control study matched patients in a 2:1 ratio of nonfallers to fallers. Data from The Ohio State University Wexner Medical Center (OSUWMC) reported fall events and patient electronic medical records were utilized. A total of 168 adult Blood and Marrow Transplant inpatients with a hematological malignancy diagnosis were evaluated from 1 January 2010 to 30 September 2012. Results Univariable and multivariable conditional logistic regression models were used to assess the relationship between potential predictor variables of interest and falls. Variables that were found to be significant predictors of falls from the univariable models include age group, incontinence, benzodiazepines, corticosteroids, anticonvulsants and antidepressants, and number of days status-post transplant. When considered for a multivariable model age group, corticosteroids, and a cancer diagnosis of leukemia were significant in the final model. Conclusion Recent medication utilization such as benzodiazepines, anticonvulsants, corticosteroids, and antidepressants placed patients at a higher risk of experiencing a fall. Other significant factors identified from a multivariable analysis found were patients older than age 65, patients with recent corticosteroid administration and a cancer diagnosis of leukemia.
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Affiliation(s)
- Cory M Vela
- 1 H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lisa M Grate
- 2 University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Ali McBride
- 3 University of Arizona Cancer Center, Tuscon, AZ, USA
| | - Steven Devine
- 4 The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Leslie A Andritsos
- 4 The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Hartwell MJ, Özbek U, Holler E, Renteria AS, Major-Monfried H, Reddy P, Aziz M, Hogan WJ, Ayuk F, Efebera YA, Hexner EO, Bunworasate U, Qayed M, Ordemann R, Wölfl M, Mielke S, Pawarode A, Chen YB, Devine S, Harris AC, Jagasia M, Kitko CL, Litzow MR, Kröger N, Locatelli F, Morales G, Nakamura R, Reshef R, Rösler W, Weber D, Wudhikarn K, Yanik GA, Levine JE, Ferrara JL. An early-biomarker algorithm predicts lethal graft-versus-host disease and survival. JCI Insight 2017; 2:e89798. [PMID: 28194439 DOI: 10.1172/jci.insight.89798] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND. No laboratory test can predict the risk of nonrelapse mortality (NRM) or severe graft-versus-host disease (GVHD) after hematopoietic cellular transplantation (HCT) prior to the onset of GVHD symptoms. METHODS. Patient blood samples on day 7 after HCT were obtained from a multicenter set of 1,287 patients, and 620 samples were assigned to a training set. We measured the concentrations of 4 GVHD biomarkers (ST2, REG3α, TNFR1, and IL-2Rα) and used them to model 6-month NRM using rigorous cross-validation strategies to identify the best algorithm that defined 2 distinct risk groups. We then applied the final algorithm in an independent test set (n = 309) and validation set (n = 358). RESULTS. A 2-biomarker model using ST2 and REG3α concentrations identified patients with a cumulative incidence of 6-month NRM of 28% in the high-risk group and 7% in the low-risk group (P < 0.001). The algorithm performed equally well in the test set (33% vs. 7%, P < 0.001) and the multicenter validation set (26% vs. 10%, P < 0.001). Sixteen percent, 17%, and 20% of patients were at high risk in the training, test, and validation sets, respectively. GVHD-related mortality was greater in high-risk patients (18% vs. 4%, P < 0.001), as was severe gastrointestinal GVHD (17% vs. 8%, P < 0.001). The same algorithm can be successfully adapted to define 3 distinct risk groups at GVHD onset. CONCLUSION. A biomarker algorithm based on a blood sample taken 7 days after HCT can consistently identify a group of patients at high risk for lethal GVHD and NRM. FUNDING. The National Cancer Institute, American Cancer Society, and the Doris Duke Charitable Foundation.
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Affiliation(s)
| | - Umut Özbek
- Biostatistics Shared Resource Facility, TischCancer Institute, the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ernst Holler
- Blood and Marrow Transplantation Program, University of Regensburg, Regensburg, Germany
| | - Anne S Renteria
- Tisch Cancer Institute, the Icahn School of Medicine at Mount Sinai
| | | | - Pavan Reddy
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Mina Aziz
- Tisch Cancer Institute, the Icahn School of Medicine at Mount Sinai
| | - William J Hogan
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Germany
| | - Yvonne A Efebera
- Blood and Marrow Transplantation Program, Ohio State University, Columbus, Ohio, USA
| | - Elizabeth O Hexner
- Blood and Marrow Transplantation Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Udomsak Bunworasate
- Blood and Marrow Transplantation Program, Chulalongkorn University, Bangkok, Thailand
| | - Muna Qayed
- Pediatric Blood and Marrow Transplantation Program, Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Rainer Ordemann
- Blood and Marrow Transplantation Program, University Hospital TU Dresden, Dresden, Germany
| | - Matthias Wölfl
- Pediatric Blood and Marrow Transplantation Program, Children's Hospital
| | - Stephan Mielke
- Blood and Marrow Transplantation Program, University of Würzburg, Würzburg, Germany
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Yi-Bin Chen
- Bone Marrow Transplantation Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven Devine
- Blood and Marrow Transplantation Program, Ohio State University, Columbus, Ohio, USA
| | - Andrew C Harris
- Blood and Marrow Transplantation Program, University of Utah, Salt Lake City, Utah, USA
| | | | - Carrie L Kitko
- Pediatric Blood and Marrow Transplantation Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark R Litzow
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Germany
| | - Franco Locatelli
- Pediatric Blood and Marrow Transplantation Program, Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | - George Morales
- Tisch Cancer Institute, the Icahn School of Medicine at Mount Sinai
| | - Ryotaro Nakamura
- Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California, USA
| | - Ran Reshef
- Blood and Marrow Transplantation Program, Columbia University Medical Center, New York, New York, USA
| | - Wolf Rösler
- Department of Internal Medicine 5, Hematology/Oncology, University Hospital Erlangen-Nuremburg, Erlangen, Germany
| | - Daniela Weber
- Blood and Marrow Transplantation Program, University of Regensburg, Regensburg, Germany
| | - Kitsada Wudhikarn
- Blood and Marrow Transplantation Program, Chulalongkorn University, Bangkok, Thailand
| | - Gregory A Yanik
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - John E Levine
- Tisch Cancer Institute, the Icahn School of Medicine at Mount Sinai
| | - James Lm Ferrara
- Tisch Cancer Institute, the Icahn School of Medicine at Mount Sinai
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Zhao S, Zhang L, Han J, Chu J, Wang H, Chen X, Wang Y, Tun N, Lu L, Bai XF, Yearsley M, Devine S, He X, Yu J. Conformal Nanoencapsulation of Allogeneic T Cells Mitigates Graft-versus-Host Disease and Retains Graft-versus-Leukemia Activity. ACS Nano 2016; 10:6189-200. [PMID: 27224853 PMCID: PMC5514314 DOI: 10.1021/acsnano.6b02206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Allogeneic transplantation of hematopoietic stem cells (HSC) in combination with T cells has a curative potential for hematopoietic malignancies through graft-versus-leukemia (GVL) effects, but is often compromised by the notorious side effect of graft-versus-host disease (GVHD) resulting from alloreactivity of the donor T cells. Here, we tested if temporary immunoisolation achieved by conformally encapsulating the donor T cells within a biocompatible and biodegradable porous film (∼450 nm in thickness) of chitosan and alginate could attenuate GVHD without compromising GVL. The nanoencapsulation was found not to affect the phenotype of T cells in vitro in terms of size, viability, proliferation, cytokine secretion, and cytotoxicity against tumor cells. Moreover, the porous nature of the nanoscale film allowed the encapsulated T cells to communicate with their environment, as evidenced by their intact capability of binding to antibodies. Lethally irradiated mice transplanted with bone marrow cells (BMCs) and the conformally encapsulated allogeneic T cells exhibited significantly improved survival and reduced GVHD together with minimal liver damage and enhanced engraftment of donor BMCs, compared to the transplantation of BMCs and non-encapsulated allogeneic T cells. Moreover, the conformal nanoencapsulation did not compromise the GVL effect of the donor T cells. These data show that conformal nanoencapsulation of T cells within biocompatible and biodegradable nanoscale porous materials is a potentially safe and effective approach to improve allogeneic HSC transplantation for treating hematological malignancies and possibly other diseases.
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Affiliation(s)
- Shuting Zhao
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio 43210, United States
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio 43210, United States
| | - Lingling Zhang
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, United States
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China
| | - Jianfeng Han
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, United States
| | - Jianhong Chu
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, United States
- Suzhou Institute of Blood and Marrow Transplantation, Soochow University, Suzhou 215000, China
| | - Hai Wang
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio 43210, United States
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio 43210, United States
| | - Xilin Chen
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, United States
| | - Youwei Wang
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, United States
| | - Norm Tun
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, United States
| | - Lanchun Lu
- Department of Radiation Oncology, The Ohio State University, Columbus, Ohio 43210, United States
| | - Xue-Feng Bai
- Department of Pathology, The Ohio State University, Columbus, Ohio 43210, United States
| | - Martha Yearsley
- Department of Pathology, The Ohio State University, Columbus, Ohio 43210, United States
| | - Steven Devine
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, United States
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio 43210, United States
- The James Cancer Hospital, The Ohio State University, Columbus, Ohio 43210, United States
| | - Xiaoming He
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio 43210, United States
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio 43210, United States
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, United States
| | - Jianhua Yu
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, United States
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio 43210, United States
- The James Cancer Hospital, The Ohio State University, Columbus, Ohio 43210, United States
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39
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Deol A, Sengsayadeth S, Ahn KW, Wang HL, Aljurf M, Antin JH, Battiwalla M, Bornhauser M, Cahn JY, Camitta B, Chen YB, Cutler CS, Gale RP, Ganguly S, Hamadani M, Inamoto Y, Jagasia M, Kamble R, Koreth J, Lazarus HM, Liesveld J, Litzow MR, Marks DI, Nishihori T, Olsson RF, Reshef R, Rowe JM, Saad AA, Sabloff M, Schouten HC, Shea TC, Soiffer RJ, Uy GL, Waller EK, Wiernik PH, Wirk B, Woolfrey AE, Bunjes D, Devine S, de Lima M, Sandmaier BM, Weisdorf D, Khoury HJ, Saber W. Does FLT3 mutation impact survival after hematopoietic stem cell transplantation for acute myeloid leukemia? A Center for International Blood and Marrow Transplant Research (CIBMTR) analysis. Cancer 2016; 122:3005-3014. [PMID: 27315441 DOI: 10.1002/cncr.30140] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 03/07/2016] [Revised: 04/18/2016] [Accepted: 05/03/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with FMS like tyrosine kinase 3 (FLT3)-mutated acute myeloid leukemia (AML) have a poor prognosis and are referred for early allogeneic hematopoietic stem cell transplantation (HCT). METHODS Data from the Center for International Blood and Marrow Transplant Research (CIBMTR) were used to evaluate 511 adult patients with de novo AML who underwent HCT during 2008 through 2011 to determine whether FLT3 mutations had an impact on HCT outcomes. RESULTS In total, 158 patients (31%) had FLT3 mutations. Univariate and multivariate analyses revealed an increased risk of relapse at 3 years in the FLT3 mutated group compared with the wild-type (WT) group (38% [95% confidence interval (CI), 30%-45%] vs 28% [95% CI, 24%-33%]; P = .04; relative risk, 1.60 [95% CI, 1.15-2.22]; P = .0048). However, FLT3 mutation status was not significantly associated with nonrelapse mortality, leukemia-free survival, or overall survival. Although more patients in the FLT3 mutated group died from relapsed primary disease compared with those in the WT group (60% vs 46%), the 3-year overall survival rate was comparable for the 2 groups (mutated group: 49%; 95% CI, 40%-57%; WT group: 55%, 95% CI, 50%-60%; P = .20). CONCLUSIONS The current data indicate that FLT3 mutation status did not adversely impact overall survival after HCT, and about 50% of patients with this mutation who underwent HCT were long-term survivors. Cancer 2016;122:3005-3014. © 2016 American Cancer Society.
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Affiliation(s)
- Abhinav Deol
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | - Kwang Woo Ahn
- CIBMTR, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI
| | - Hai-Lin Wang
- CIBMTR, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riydah, Saudi Arabia
| | - Joseph Harry Antin
- Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Minoo Battiwalla
- Hematology Branch, National Heart Lung and Blood Institute, Bethesda, MD
| | | | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Bruce Camitta
- Midwest Center for Cancer and Blood Disorders, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
| | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Corey S Cutler
- Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS
| | - Mehdi Hamadani
- CIBMTR, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Rammurti Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX
| | - John Koreth
- Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Jane Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Mark R Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester
| | - David I Marks
- Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research, Sormland, Uppsala University, Uppsala, Sweden
| | - Ran Reshef
- Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Jacob M Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ayman A Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa and Ottawa Hospital Research institute, Ottawa, Canada
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
| | - Thomas C Shea
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina Health Care, Chapel Hill, NC
| | - Robert J Soiffer
- Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Geoffrey L Uy
- Divsion of Onocology, Washington University School of Medicine, St. Louis, MO
| | - Edmond K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Insitute, Emory University, Atlanta, GA
| | | | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA
| | | | - Donald Bunjes
- Department of Internal Medicine III, Universitatsklinkum Ulm, Ulm, Germany
| | - Steven Devine
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center- James, Columbus, OH
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Hanna Jean Khoury
- Department of Hematology and Medical Oncology, Winship Cancer Insitute, Emory University, Atlanta, GA
| | - Wael Saber
- CIBMTR, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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40
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Ustun C, Gotlib J, Popat U, Artz A, Litzow M, Reiter A, Nakamura R, Kluin-Nelemans HC, Verstovsek S, Gajewski J, Perales MA, George T, Shore T, Sperr W, Saber W, Kota V, Yavuz AS, Pullarkat V, Rogosheske J, Hogan W, Van Besien K, Hagglund H, Damaj G, Arock M, Horny HP, Metcalfe DD, Deeg HJ, Devine S, Weisdorf D, Akin C, Valent P. Consensus Opinion on Allogeneic Hematopoietic Cell Transplantation in Advanced Systemic Mastocytosis. Biol Blood Marrow Transplant 2016; 22:1348-1356. [PMID: 27131865 DOI: 10.1016/j.bbmt.2016.04.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/20/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Celalettin Ustun
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota.
| | - Jason Gotlib
- Division of Hematology, Stanford University, Stanford, California
| | - Uday Popat
- Department of Stem Cell Transplantation, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Andrew Artz
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mark Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Minneapolis, Minnesota
| | - Andreas Reiter
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - Ryotaro Nakamura
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
| | - Hanneke C Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Srdan Verstovsek
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James Gajewski
- Department of Hematology, Oregon Health and Science University, Portland, Oregon
| | - Miguel-Angel Perales
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tracy George
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Tsiporah Shore
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, New York
| | - Wolfgang Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - Wael Saber
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vamsi Kota
- Division of Hematology, Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Akif Selim Yavuz
- Division of Hematology, Istanbul Medical School, University of Istanbul, Istanbul, Turkey
| | - Vinod Pullarkat
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
| | - John Rogosheske
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - William Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Minneapolis, Minnesota
| | - Koen Van Besien
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Hans Hagglund
- Division of Hematology, Department of Medical Sciences Uppsala University, Uppsala, Sweden
| | - Gandhi Damaj
- Department of Hematology, Hematology Institute, University Hospital, School of Medicine, University of Basse-Normandie, Caen, France
| | - Michel Arock
- Cellular and Molecular Oncology Unit, CNRS UMR 8113, Ecole Normale Supériede Cachan, Cachan, France and Laboratoire d'Hématologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
| | | | - Dean D Metcalfe
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, University of Washington, Seattle, Washington
| | - Steven Devine
- Division of Hematology, Department of Medicine, Ohio State University and the Ohio State University Comprehensive Cancer Center, Ohio
| | - Daniel Weisdorf
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Cem Akin
- Division of Rheumatology, Immunology, and Allergy, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
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41
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DeBoer R, Koval G, Mulkey F, Wetzler M, Devine S, Marcucci G, Stone RM, Larson RA, Bloomfield CD, Geyer S, Mullighan CG, Stock W. Clinical impact of ABL1 kinase domain mutations and IKZF1 deletion in adults under age 60 with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL): molecular analysis of CALGB (Alliance) 10001 and 9665. Leuk Lymphoma 2016; 57:2298-306. [PMID: 26892479 DOI: 10.3109/10428194.2016.1144881] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent studies have identified oncogenic lesions in Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) and ABL1 kinase mutations that confer resistance to tyrosine kinase inhibitors. We sought to determine the prevalence and clinical impact of these lesions in patients on CALGB 10001, a previously reported Phase II study of imatinib, chemotherapy, and hematopoietic cell transplant in adult Ph + ALL. Of the 58 enrolled, 22 relapsed. By direct sequencing, an ABL1 kinase mutation known to induce imatinib resistance was present at relapse in 13 of 20. Using quantitative PCR assays, the mutations were detectable at diagnosis or early during treatment in most (62%) relapsed patients. Aberrations in IKZF1, CDKN2A/B, and PAX5 were assessed in 28 samples using SNP arrays and genomic DNA sequencing. Of these, 22 (79%) had IKZF1 deletion. The combination of IKZF1 deletion and p210 BCR-ABL1 (p < 0.0001), high white blood cell count (p = 0.021), and minimal residual disease (p = 0.013) were associated with worse disease-free survival.
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Affiliation(s)
- Rebecca DeBoer
- a Department of Medicine , University of Chicago Medical Center , Chicago , IL , USA
| | - Gregory Koval
- a Department of Medicine , University of Chicago Medical Center , Chicago , IL , USA
| | - Flora Mulkey
- b Alliance Statistics and Data Center , Duke University Medical Center , Durham , NC , USA
| | - Meir Wetzler
- c Roswell Park Cancer Institute , Buffalo , NY , USA
| | - Steven Devine
- d The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Guido Marcucci
- e City of Hope Comprehensive Cancer Center , Duarte , CA , USA
| | - Richard M Stone
- f Dana-Farber Cancer Institute, Harvard Medical School , Boston , MA , USA
| | - Richard A Larson
- a Department of Medicine , University of Chicago Medical Center , Chicago , IL , USA
| | - Clara D Bloomfield
- d The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Susan Geyer
- g Health Informatics Institute, University of South Florida , Tampa , FL , USA
| | | | - Wendy Stock
- a Department of Medicine , University of Chicago Medical Center , Chicago , IL , USA
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42
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Ustun C, Smith A, Cayci Z, Courville EL, Corbacioglu S, Akin C, Horny HP, Valent P, Devine S, Weisdorf DJ. Allogeneic hematopoietic cell transplantation in systemic mastocytosis: is there a high risk for veno-occlusive disease? Eur J Haematol 2016; 96:655-7. [PMID: 26679533 DOI: 10.1111/ejh.12720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Celalettin Ustun
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Angela Smith
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Zuzan Cayci
- Department Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth L Courville
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | | | - Cem Akin
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hans Peter Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Peter Valent
- Division of Haematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Steven Devine
- Division of Hematology, The Ohio State University-James Comprehensive Cancer Center, Columbus, OH, USA
| | - Daniel J Weisdorf
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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43
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Harris AC, Young R, Devine S, Hogan WJ, Ayuk F, Bunworasate U, Chanswangphuwana C, Efebera YA, Holler E, Litzow M, Ordemann R, Qayed M, Renteria AS, Reshef R, Wölfl M, Chen YB, Goldstein S, Jagasia M, Locatelli F, Mielke S, Porter D, Schechter T, Shekhovtsova Z, Ferrara JLM, Levine JE. International, Multicenter Standardization of Acute Graft-versus-Host Disease Clinical Data Collection: A Report from the Mount Sinai Acute GVHD International Consortium. Biol Blood Marrow Transplant 2015; 22:4-10. [PMID: 26386318 DOI: 10.1016/j.bbmt.2015.09.001] [Citation(s) in RCA: 446] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
Acute graft-versus-host disease (GVHD) remains a leading cause of morbidity and nonrelapse mortality after allogeneic hematopoietic cell transplantation. The clinical staging of GVHD varies greatly between transplant centers and is frequently not agreed on by independent reviewers. The lack of standardized approaches to handle common sources of discrepancy in GVHD grading likely contributes to why promising GVHD treatments reported from single centers have failed to show benefit in randomized multicenter clinical trials. We developed guidelines through international expert consensus opinion to standardize the diagnosis and clinical staging of GVHD for use in a large international GVHD research consortium. During the first year of use, the guidance followed discussion of complex clinical phenotypes by experienced transplant physicians and data managers. These guidelines increase the uniformity of GVHD symptom capture, which may improve the reproducibility of GVHD clinical trials after further prospective validation.
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Affiliation(s)
- Andrew C Harris
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan; Blood and Marrow Transplantation Program, University of Utah, Salt Lake City, Utah
| | - Rachel Young
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan; Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Steven Devine
- Blood and Marrow Transplantation Program, Ohio State University, Columbus, Ohio
| | - William J Hogan
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, Minnesota
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Germany
| | - Udomsak Bunworasate
- Blood and Marrow Transplantation Program, Chulalongkorn University, Bangkok, Thailand
| | | | - Yvonne A Efebera
- Blood and Marrow Transplantation Program, Ohio State University, Columbus, Ohio
| | - Ernst Holler
- Blood and Marrow Transplantation Program, University of Regensburg, Regensburg, Germany
| | - Mark Litzow
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, Minnesota
| | - Rainer Ordemann
- Blood and Marrow Transplantation Program, University Hospital TU Dresden, Dresden, Germany
| | - Muna Qayed
- Pediatric Blood and Marrow Transplantation Program, Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Anne S Renteria
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Ran Reshef
- Blood and Marrow Transplantation Program, Columbia University Medical Center, New York, New York
| | - Matthias Wölfl
- Pediatric Blood and Marrow Transplantation Program, Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Yi-Bin Chen
- Bone Marrow Transplantation Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven Goldstein
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Madan Jagasia
- Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Franco Locatelli
- Pediatric Blood and Marrow Transplantation Program, Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | - Stephan Mielke
- Blood and Marrow Transplantation Program, University of Würzburg, Würzburg, Germany
| | - David Porter
- Blood and Marrow Transplantation Program, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tal Schechter
- Pediatric Blood and Marrow Transplantation Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zhanna Shekhovtsova
- Federal Clinical Research Center for Children's Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - James L M Ferrara
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - John E Levine
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan; Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
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44
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O'Brien S, Radich JP, Abboud CN, Akhtari M, Altman JK, Berman E, Curtin P, DeAngelo DJ, Deininger M, Devine S, Fathi AT, Gotlib J, Jagasia M, Kropf P, Moore JO, Pallera A, Reddy VV, Shah NP, Smith BD, Snyder DS, Wetzler M, Gregory K, Sundar H. Chronic myelogenous leukemia, version 1.2015. J Natl Compr Canc Netw 2015; 12:1590-610. [PMID: 25361806 DOI: 10.6004/jnccn.2014.0159] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic myelogenous leukemia (CML) is usually diagnosed in the chronic phase. Untreated chronic phase CML will eventually progress to advanced phase (accelerated or blast phase) CML. Tyrosine kinase inhibitors (TKIs) have been shown to induce favorable response rates in patients with accelerated and blast phase CML. The addition of TKIs to chemotherapy has also been associated with improved outcomes in patients with blast phase CML. Allogeneic hematopoietic stem cell transplant remains a potentially curative option for patients with advanced phase CML, although treatment with a course of TKIs will be beneficial as a bridge to transplant. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with advanced phase CML.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Guidelines as Topic
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Leukemia, Myeloid, Accelerated Phase/diagnosis
- Leukemia, Myeloid, Accelerated Phase/drug therapy
- Leukemia, Myeloid, Accelerated Phase/surgery
- Leukemia, Myeloid, Chronic-Phase/diagnosis
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/surgery
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
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45
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Sborov DW, Benson DM, Williams N, Huang Y, Bowers MA, Humphries K, Efebera Y, Devine S, Hofmeister CC. Lenalidomide and vorinostat maintenance after autologous transplant in multiple myeloma. Br J Haematol 2015; 171:74-83. [PMID: 26058589 DOI: 10.1111/bjh.13527] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 04/27/2015] [Indexed: 01/31/2023]
Abstract
UNLABELLED Single-agent post-autologous transplant maintenance therapy with lenalidomide is standard of care for patients with multiple myeloma. The tolerability and effectiveness of combination post-transplant maintenance therapy is unknown, so we investigated lenalidomide and vorinostat (suberoylanilide hydroxamic acid) in this setting, hypothesizing that the regimen would be well tolerated and associated with an improved post-transplant response. This trial followed a standard 3 × 3 dose escalation phase 1 design. Vorinostat was administered beginning day +90 post-haematopoietic stem cell transplantation for days 1-7 and 15-21, and lenalidomide was started at 10 mg days 1-21, both on a 28-d cycle. The primary endpoint was maximum tolerated dose and dose limiting toxicities were assessed during the first cycle. Treatment was well tolerated in 16 enrolled patients. During Cycle 1, the most common toxicities included cytopenias, gastrointestinal complaints and fatigue. Seven patients improved their transplant response after starting combination therapy. The median follow-up was 38·4 months, and the median progression-free survival and overall survival have yet to be reached. This oral post-transplant maintenance regimen was well tolerated. This is the first trial to publish results on the use of a histone deacetylase inhibitor in the maintenance setting, and it provides rationale for the ongoing randomized trial in maintenance (ISRCTN 49407852). TRIAL REGISTRATION NCT00729118.
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Affiliation(s)
- Douglas W Sborov
- Hematology/Oncology Fellowship, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Don M Benson
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Nita Williams
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ying Huang
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Mindy A Bowers
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Kristina Humphries
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Yvonne Efebera
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Steven Devine
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Craig C Hofmeister
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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46
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Ranganathan P, Yu X, Santhanam R, Hofstetter J, Walker A, Walsh K, Bhatnagar B, Klisovic R, Vasu S, Phelps MA, Devine S, Shacham S, Kauffman M, Marcucci G, Blum W, Garzon R. Decitabine priming enhances the antileukemic effects of exportin 1 (XPO1) selective inhibitor selinexor in acute myeloid leukemia. Blood 2015; 125:2689-92. [PMID: 25716206 PMCID: PMC4408293 DOI: 10.1182/blood-2014-10-607648] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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: 10/23/2014] [Accepted: 02/15/2015] [Indexed: 12/26/2022] Open
Abstract
The prognosis of acute myeloid leukemia (AML) is poor, highlighting the need for novel treatments. Hypomethylating agents, including decitabine are used to treat elderly AML patients with relative success. Targeting nuclear export receptor (exportin 1 [XPO1]) is a novel approach to restore tumor suppressor (TS) function in AML. Here, we show that sequential treatment of AML blasts with decitabine followed by selinexor (XPO1 inhibitor) enhances the antileukemic effects of selinexor. These effects could be mediated by the re-expression of a subset of TSs (CDKN1A and FOXO3A) that are epigenetically silenced via DNA methylation, and cytoplasmic-nuclear trafficking is regulated by XPO1. We observed a significant upregulation of CDKN1A and FOXO3A in decitabine- versus control-treated cells. Sequential treatment of decitabine followed by selinexor in an MV4-11 xenograft model significantly improved survival compared with selinexor alone. On the basis of these preclinical results, a phase 1 clinical trial of decitabine followed by selinexor in elderly patients with AML has been initiated.
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MESH Headings
- Active Transport, Cell Nucleus/drug effects
- Animals
- Antineoplastic Agents/therapeutic use
- Azacitidine/analogs & derivatives
- Azacitidine/therapeutic use
- Cell Line, Tumor
- Cyclin-Dependent Kinase Inhibitor p21/genetics
- DNA Methylation/drug effects
- DNA Modification Methylases/antagonists & inhibitors
- Decitabine
- Forkhead Box Protein O3
- Forkhead Transcription Factors/genetics
- Humans
- Hydrazines/therapeutic use
- Karyopherins/antagonists & inhibitors
- Karyopherins/metabolism
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Receptors, Cytoplasmic and Nuclear/antagonists & inhibitors
- Receptors, Cytoplasmic and Nuclear/metabolism
- Triazoles/therapeutic use
- Tumor Cells, Cultured
- Up-Regulation/drug effects
- Exportin 1 Protein
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Affiliation(s)
- Parvathi Ranganathan
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - Xueyan Yu
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - Ramasamy Santhanam
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - Jessica Hofstetter
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - Alison Walker
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - Katherine Walsh
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - Bhavana Bhatnagar
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - Rebecca Klisovic
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - Mitch A Phelps
- The College of Pharmacy, The Ohio State University, Columbus, OH; and
| | - Steven Devine
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | | | | | - Guido Marcucci
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - William Blum
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
| | - Ramiro Garzon
- Division of Hematology, Department of Internal Medicine, The Comprehensive Cancer Center, and
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47
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Appelbaum FR, Anasetti C, Antin JH, Atkins H, Davies S, Devine S, Giralt S, Heslop H, Laport G, Lee SJ, Logan B, Pasquini M, Pulsipher M, Stadtmauer E, Wingard JR, Horowitz MM. Blood and marrow transplant clinical trials network state of the Science Symposium 2014. Biol Blood Marrow Transplant 2015; 21:202-24. [PMID: 25445636 PMCID: PMC4426907 DOI: 10.1016/j.bbmt.2014.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Frederick R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Claudio Anasetti
- Research & Clinical Trials, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Joseph H Antin
- Stem Cell Transplants, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Harold Atkins
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Stella Davies
- Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Steven Devine
- Blood and Marrow Transplant Program, The Ohio State University, Columbus, Ohio
| | - Sergio Giralt
- Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Helen Heslop
- Adult Bone Marrow and Stem Cell Transplant Program, Baylor College of Medicine, Houston, Texas
| | - Ginna Laport
- Medicine-Blood & Marrow Transplantation, Stanford Hospital and Clinics, Stanford, California
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brent Logan
- Clinical Research Division, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo Pasquini
- Clinical Research Division, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Pulsipher
- Biostatistics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
| | - Edward Stadtmauer
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John R Wingard
- Hematology Division-Internal Medicine Department, University of Florida, Gainesville, Florida
| | - Mary M Horowitz
- Clinical Research Division, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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48
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Majhail NS, Chitphakdithai P, Logan B, King R, Devine S, Rossmann SN, Hale G, Hartzman RJ, Karanes C, Laport GG, Nemecek E, Snyder EL, Switzer GE, Miller J, Navarro W, Confer DL, Levine JE. Significant improvement in survival after unrelated donor hematopoietic cell transplantation in the recent era. Biol Blood Marrow Transplant 2014; 21:142-50. [PMID: 25445638 DOI: 10.1016/j.bbmt.2014.10.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/02/2014] [Indexed: 10/24/2022]
Abstract
Patients and physicians may defer unrelated donor hematopoietic cell transplantation (HCT) as curative therapy because of the mortality risk associated with the procedure. Therefore, it is important for physicians to know the current outcomes data when counseling potential candidates. To provide this information, we evaluated 15,059 unrelated donor hematopoietic cell transplant recipients between 2000 and 2009. We compared outcomes before and after 2005 for 4 cohorts: age <18 years with malignant diseases (n = 1920), ages 18 to 59 years with malignant diseases (n = 9575), ages ≥ 60 years with malignant diseases (n = 2194), and nonmalignant diseases (n = 1370). Three-year overall survival in 2005 to 2009 was significantly better in all 4 cohorts (<18 years: 55% versus 45%, 18 to 59 years: 42% versus 35%, ≥ 60 years: 35% versus 25%, nonmalignant diseases: 69% versus 60%; P < .001 for all comparisons). Multivariate analyses in leukemia patients receiving HLA 7/8 to 8/8-matched transplants showed significant reduction in overall and nonrelapse mortality in the first year after HCT among patients who underwent transplantation in 2005 to 2009; however, risks for relapse did not change over time. Significant survival improvements after unrelated donor HCT have occurred over the recent decade and can be partly explained by better patient selection (eg, HCT earlier in the disease course and lower disease risk), improved donor selection (eg, more precise allele-level matched unrelated donors) and changes in transplantation practices.
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Affiliation(s)
- Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio; National Marrow Donor Program, Minneapolis, Minnesota
| | | | - Brent Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Roberta King
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Steven Devine
- Blood and Marrow Transplant Program, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | - Gregory Hale
- Pediatric Hematology, Oncology and BMT, All Children's Hospital, St Petersburg, Florida
| | | | - Chatchada Karanes
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Ginna G Laport
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Eneida Nemecek
- Pediatric Blood and Marrow Transplant Program, Oregon Health Science University, Portland, Oregon
| | - Edward L Snyder
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Galen E Switzer
- Departments of Medicine and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Miller
- National Marrow Donor Program, Minneapolis, Minnesota
| | | | | | - John E Levine
- Division of Pediatric Hematology/Oncology, University of Michigan Medical Center, Ann Arbor, Michigan.
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49
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Dubovsky JA, Flynn R, Du J, Harrington BK, Zhong Y, Yang C, Towns W, Lehman A, Johnson A, Devine S, Jaglowski S, Serody JS, Murphy WJ, Munn DH, Luznik L, Hill G, MacDonald KK, Maillard I, Koreth J, Cutler C, Soiffer RJ, Antin JH, Ritz J, Panoskaltsis-Mortari A, Byrd JC, Blazar BR. Abstract 2591: Ibrutinib can reverse established chronic graft-versus-host disease, which is dependent upon IL-2 inducible T-cell kinase (ITK) and Bruton's tyrosine kinase (BTK)-driven lymphocyte activation. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2591] [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: 11/16/2022]
Abstract
Abstract
Chronic graft versus host disease (cGVHD) is a life threatening impediment to the otherwise curative potential of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Intensive study has unveiled the lymphoid subsets that drive multifaceted autoimmune and fibrotic cascades which disrupt healthy tissues. Clinical and in-vivo data implicate B-cells and certain subsets of CD4 helper T-cells in the development and progression of cGVHD. These specific immune subsets are unique in their singular dependence upon the TEC-family kinases BTK or ITK for receptor driven activation. Ibrutinib is an irreversible inhibitor of BTK and ITK that has produced durable remissions in B-cell malignancies with minimal toxicity. We sought to examine ibrutinib's potential to attenuate B-cell and CD4 T-cell driven anti-host immunity in the setting of cGVHD. We utilized two complementary murine models independently focused on interrogating sclerodermatous T-cell driven cGVHD (LPJ→C57BL/6) or alloantibody driven bronchiolar obliterans (BO) and multi-organ system disease without skin involvement (C57BL/6→B10.BR). We examined therapeutic administration of 25mg/kg/day ibrutinib initiated when mice first develop signs of cGVHD (25-28 days after allo-HSCT). In the minor-MHC mismatch LPJ→C57BL/6 model, ibrutinib significantly extended median time to cGVHD progression by 14 days and 33% (6 of 18) of ibrutinib treated mice remained progression free as compared to 12% (2 of 18) of mice receiving vehicle and 10% (1 of 11) of mice receiving cyclosporine 10mg/kg/day (p<0.02). Overall survival was also highest in the ibrutinib treatment cohort. Mice receiving ibrutinib showed restoration of external cGVHD criterion including body weight, posture, skin lesions, hair loss, and mobility. There was significant ablation of lymphohistiocytic T- and B-cell pulmonary and renal infiltration in ibrutinib treated animals. Data from the C57BL/6→B10.BR model confirmed the efficacy of ibrutinib in significantly restoring pulmonary compliance, elastance, and resistance to levels indistinguishable from that of a healthy animal and significantly better than cGVHD vehicle treated controls (n=12/group)(p<0.01). These results were associated with significantly decreased alloantibody deposition and decreased fibrosis in the lungs of ibrutinib treated mice. Germinal center (GC) reactions, required for multi-organ system pathology in this model, were also significantly reduced within the spleens of mice receiving therapeutic ibrutinib (p<0.05). Using in-vivo genetic ablation models, we demonstrate the critical nature of BTK and ITK respectively in the development of cGVHD pathognomonic BO. Our data support ibrutinib as a promising therapeutic direction for the treatment of cGVHD by virtue of its ability to suppress BTK and ITK signaling.
Citation Format: Jason A. Dubovsky, Ryan Flynn, Jing Du, Bonnie K. Harrington, Yiming Zhong, Carrie Yang, William Towns, Amy Lehman, Amy Johnson, Steven Devine, Samantha Jaglowski, Jonathan S. Serody, William J. Murphy, David H. Munn, Leo Luznik, Geoffrey Hill, Kelli K.P. MacDonald, Ivan Maillard, John Koreth, Corey Cutler, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Angela Panoskaltsis-Mortari, John C. Byrd, Bruce R. Blazar. Ibrutinib can reverse established chronic graft-versus-host disease, which is dependent upon IL-2 inducible T-cell kinase (ITK) and Bruton's tyrosine kinase (BTK)-driven lymphocyte activation. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2591. doi:10.1158/1538-7445.AM2014-2591
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Affiliation(s)
- Jason A. Dubovsky
- 1The Ohio State University, Division of Hematology-Oncology, Columbus, OH
| | - Ryan Flynn
- 2University of Minnesota, Minneapolis, MN
| | - Jing Du
- 2University of Minnesota, Minneapolis, MN
| | | | - Yiming Zhong
- 1The Ohio State University, Division of Hematology-Oncology, Columbus, OH
| | - Carrie Yang
- 1The Ohio State University, Division of Hematology-Oncology, Columbus, OH
| | - William Towns
- 1The Ohio State University, Division of Hematology-Oncology, Columbus, OH
| | - Amy Lehman
- 1The Ohio State University, Division of Hematology-Oncology, Columbus, OH
| | - Amy Johnson
- 1The Ohio State University, Division of Hematology-Oncology, Columbus, OH
| | - Steven Devine
- 1The Ohio State University, Division of Hematology-Oncology, Columbus, OH
| | - Samantha Jaglowski
- 1The Ohio State University, Division of Hematology-Oncology, Columbus, OH
| | | | - William J. Murphy
- 4University of California–Davis Cancer Center and School of Medicine, Sacramento, CA
| | | | - Leo Luznik
- 6Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, MD
| | - Geoffrey Hill
- 7Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia
| | - Kelli K.P. MacDonald
- 7Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia
| | - Ivan Maillard
- 8Life Sciences Institute, University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | | | - John C. Byrd
- 1The Ohio State University, Division of Hematology-Oncology, Columbus, OH
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Barker JN, Fei M, Karanes C, Horwitz M, Devine S, Kindwall-Keller TL, Holter J, Adams A, Logan B, Navarro WH, Riches M. Results of a prospective multicentre myeloablative double-unit cord blood transplantation trial in adult patients with acute leukaemia and myelodysplasia. Br J Haematol 2014; 168:405-12. [PMID: 25272241 DOI: 10.1111/bjh.13136] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/14/2014] [Indexed: 11/29/2022]
Abstract
Double-unit cord blood (CB) grafts may improve engraftment and relapse risk in adults with haematological malignancies. We performed a prospective high-dose myeloablative double-unit CB transplantation (CBT) trial in adults with high-risk acute leukaemia or myelodysplasia (MDS) between 2007 and 2011. The primary aim was to establish the 1-year overall survival in a multi-centre setting. Fifty-six patients (31 acute myeloid leukaemia, 19 acute lymphoblastic leukaemia, 4 other acute leukaemias, 2 myelodysplastic syndrome [MDS]) were transplanted at 10 centres. The median infused total nucleated cell doses were 2·62 (larger unit) and 2·02 (smaller unit) x 10(7) /kg. The cumulative incidence of day 100 neutrophil engraftment was 89% (95% confidence interval [CI]: 80-96). Day 180 grade II-IV acute graft-versus-host disease (GVHD) incidence was 64% (95%CI: 51-76) and 36% (95%CI: 24-49) of patients had chronic GVHD by 3-years. At 3-years post-transplant, the transplant-related mortality (TRM) was 39% (95%CI: 26-52), and the 3-year relapse incidence was 11% (95%CI: 4-21). With a median 37-month (range 23-71) follow-up of survivors, the 3-year disease-free survival was 50% (95%CI: 37-63). Double-unit CBT is a viable alternative therapy for high-risk acute leukaemia/ MDS in patients lacking a matched unrelated donor. This is especially important for minority patients. The relapse incidence was low but strategies to ameliorate TRM are needed.
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Affiliation(s)
- Juliet N Barker
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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