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Khouderchah CJ, Ochs M, Pianko M, Mahmoudjafari Z, Snyder J, Ahmed I, Campagnaro E, Nachar VR. Administration of teclistamab in four patients with multiple myeloma requiring hemodialysis. J Oncol Pharm Pract 2024:10781552241242022. [PMID: 38576408 DOI: 10.1177/10781552241242022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Relapsed/refractory multiple myeloma (MM) has poor outcomes, especially in heavily pretreated patients. Limited data exists on the use of novel therapies in MM patients with renal dysfunction. This case series describes the successful initiation of teclistamab in four patients with heavily pre-treated MM on hemodialysis (HD). DATA SOURCES The medical records of four adult MM patients on HD who received teclistamab were retrospectively reviewed. DATA SUMMARY All patients completed teclistamab step-up dosing and received at least one full dose. HD runs were administered irrespective of teclistamab initiation. Patients tolerated therapy well, with only one patient experiencing grade 1 CRS, which was managed with supportive care. CONCLUSIONS Due to the complexity of this patient population, close monitoring and multidisciplinary care are crucial. This approach is essential for effectively managing MM patients with renal dysfunction and for exploring novel treatment options.
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Affiliation(s)
- Christy J Khouderchah
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI, USA
| | - Madeleine Ochs
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Matthew Pianko
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Zahra Mahmoudjafari
- Department of Pharmacy, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Jordan Snyder
- Department of Pharmacy, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Iman Ahmed
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Erica Campagnaro
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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2
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Nachar VR, Perissinotti AJ, Marini BL, Karimi YH, Phillips TJ. COVID-19 infection outcomes in patients receiving CD20 targeting T-cell engaging bispecific antibodies for B-cell non-Hodgkin lymphoma. Ann Hematol 2023; 102:2635-2637. [PMID: 37294440 PMCID: PMC10250838 DOI: 10.1007/s00277-023-05315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/07/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Victoria R Nachar
- University of Michigan Rogel Cancer Center, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Anthony J Perissinotti
- University of Michigan Rogel Cancer Center, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Bernard L Marini
- University of Michigan Rogel Cancer Center, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Yasmin H Karimi
- University of Michigan Rogel Cancer Center, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Tycel J Phillips
- University of Michigan Rogel Cancer Center, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
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3
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Davis JA, Granger K, Sakowski A, Goodwin S, Herbst A, Smith D, Hendrickson L, Nachar VR. Dual target dilemma: navigating epcoritamab vs. glofitamab in relapsed refractory diffuse large B-cell lymphoma. Expert Rev Hematol 2023; 16:915-918. [PMID: 37982732 DOI: 10.1080/17474086.2023.2285978] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Affiliation(s)
- James A Davis
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Katelynn Granger
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Alex Sakowski
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Sara Goodwin
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Amanda Herbst
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Deidra Smith
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Lindsey Hendrickson
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Victoria R Nachar
- Department of Pharmacy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
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4
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Bici A, Pianko MJ, Nachar VR. Incidence and risk factors for bacterial infection using bortezomib, lenalidomide, and dexamethasone (RVd) in newly diagnosed multiple myeloma. Leuk Lymphoma 2023; 64:407-414. [PMID: 36308285 PMCID: PMC9993956 DOI: 10.1080/10428194.2022.2138380] [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: 06/24/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 02/17/2023]
Abstract
Infections are an important cause of morbidity and mortality in newly diagnosed multiple myeloma (NDMM), but the real-world risk using modern induction regimens such as bortezomib, lenalidomide, and dexamethasone (RVd) is not well described. We performed a retrospective single-center cohort study to identify infections and risk factors in patients treated with first-line RVd from January 2014 to January 2020 and collected demographic and clinical data. Of 144 patients treated with RVd for NDMM, 21 patients (14.5%) experienced a bacterial infection during induction, of which 8 (5.5%) were grade 3 infections despite a low rate of antibiotic prophylaxis use (12%). Grade 3 neutropenia occurred in 11% of patients, 2% had febrile neutropenia and there were no deaths from infection. On multivariable analysis, age, smoking history, diabetes, antibiotic use in the 60 days preceding the start of RVd, and high-risk cytogenetics were associated with higher risk of bacterial infection.
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Affiliation(s)
- Anisa Bici
- Department of Pharmacy Services, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, MI, United States
| | - Matthew J. Pianko
- Division of Hematology and Oncology, Department of Internal Medicine, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
| | - Victoria R Nachar
- Department of Pharmacy Services, University of Michigan Rogel Cancer Center, Ann Arbor, MI, United States
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5
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Dela-Pena JC, King MA, Brown J, Nachar VR. Incorporation of novel therapies for the management of sickle cell disease: A pharmacist's perspective. J Oncol Pharm Pract 2022; 28:646-663. [DOI: 10.1177/10781552211072468] [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: 11/17/2022]
Abstract
Patients with sickle cell disease (SCD) experience significant disease-related morbidity including multiorgan damage, chronic anemia, and debilitating pain crises. While hydroxyurea has been the primary disease modifying modality in SCD, novel therapies with unique mechanism of action have recently been approved. This review article examines the evidence surrounding the available SCD therapies to guide pharmacists on potential treatment selection and management strategies for patients with SCD. A systematic search of online databases was performed to identify literature on the management of SCD. While the newly approved novel agents have demonstrated clinical benefit it remains unclear how these agents fit into the treatment paradigm. Pharmacists should be aware of the data supporting the use of these novel agents to optimize use on a patient-specific basis.
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Affiliation(s)
| | | | - Julia Brown
- C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
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6
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Schaefer JK, Elshoury A, Nachar VR, Streiff MB, Lim MY. How to Choose An Appropriate Anticoagulant for Cancer-Associated Thrombosis. J Natl Compr Canc Netw 2021; 19:1203-1210. [PMID: 34666314 DOI: 10.6004/jnccn.2021.7085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Venous thromboembolic disease can be a fatal complication of cancer. Despite advances in prevention, thousands of patients require treatment of cancer-associated thrombosis (CAT) each year. Guidelines have advocated low-molecular-weight heparin (LMWH) as the preferred anticoagulant for CAT for years, based on clinical trial data showing LMWH to be associated with a lower risk of recurrent thrombosis when compared with vitamin K antagonists. However, the potentially painful, subcutaneously administered LMWH injections can be expensive, and clinical practice has not been consistent with guideline recommendations. Recently, studies have compared LMWH to the direct oral anticoagulants (DOACs) for the management of CAT. Based on promising trial results outlined in this review, DOACs are now preferred anticoagulants for CAT occurring in patients without gastric or gastroesophageal lesions. For patients with gastrointestinal cancers, who may be at higher risk of hemorrhage with the DOACs, LMWH remains the anticoagulant of choice. Applying the latest data from this rapidly evolving field to care for diverse patient groups can be challenging. This article provides an evidence-based review of outpatient anticoagulant selection for lower-extremity deep vein thrombosis or pulmonary embolism in the setting of cancer, and takes into account special populations with cancer.
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Affiliation(s)
- Jordan K Schaefer
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Amro Elshoury
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Michael B Streiff
- Division of Hematology, Department of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Ming Y Lim
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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7
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Baek GT, Mathis NJ, Perissinotti AJ, Marini BL, Brown A, Phillips TJ, Wilcox RA, Nachar VR. Late-onset complications with bendamustine versus CHOP or CVP based chemoimmunotherapy in indolent Non-Hodgkin's lymphoma. Leuk Lymphoma 2021; 62:3138-3146. [PMID: 34263702 DOI: 10.1080/10428194.2021.1953014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bendamustine is a preferred first-line chemoimmunotherapy regimen for indolent non-Hodgkin's lymphoma (iNHL). Emerging evidence suggests an increased incidence of late-onset complications with bendamustine-based regimens compared with CHOP/CVP; however, this evidence is limited. We retrospectively compared late-onset complications from January 2005 to May 2020 in adults with previously untreated iNHL who received rituximab or obinutuzumab with CHOP, CVP, or bendamustine. Forty-six patients received CHOP/CVP; 119 received bendamustine. No difference in incidence of late-onset infections was observed. Bendamustine led to a higher rate of prolonged and unresolved lymphocytopenia and a greater incidence of late-onset neutropenia. Many patients receiving bendamustine did not have lymphocyte recovery even three years following administration. Ongoing infection prophylaxis with bendamustine-based regimens may offset translation of these laboratory findings to late-onset infectious risk.
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Affiliation(s)
- Grace T Baek
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI, USA
| | - Noah J Mathis
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI, USA.,College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Bernard L Marini
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI, USA.,College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Anna Brown
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI, USA.,College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Tycel J Phillips
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA
| | - Ryan A Wilcox
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI, USA.,College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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8
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Homan MJ, Reid JH, Nachar VR, Benitez LL, Brown AM, Kraft S, Hough S, Christen C, Frame D, McDevitt RL. Implementation and outcomes of a pharmacist-led collaborative drug therapy management program for oncology symptom management. Support Care Cancer 2021; 29:6505-6510. [PMID: 33905012 DOI: 10.1007/s00520-021-06239-0] [Citation(s) in RCA: 3] [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: 02/12/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Nausea, vomiting, constipation, and diarrhea are common cancer and cancer therapy adverse effects. Pharmacists are uniquely positioned to optimize patient symptom control and minimize excess use of hospital resources, such as emergency department visits. METHODS Michigan Medicine oncology clinical pharmacists have been independently providing patient symptom management through a collaborative drug therapy management (CDTM) program which established guidelines for management of gastrointestinal toxicities (nausea, vomiting, diarrhea, and/or constipation) secondary to a patient's cancer diagnosis or treatment of the cancer. Patients were referred to the pharmacist by the treating oncologist or hematologist. RESULTS From June 2019 to May 2020, there were a total of 62 patient referrals. Ten of the 62 referrals did not meet the CDTM inclusion criteria, resulting in 52 patients who were managed by the pharmacists. The total number of individual pharmacist visits was 136, with a median of 2.2 (range, 0-11) visits per patient referred. A total of 169 categorized pharmacist interventions were captured. Most interventions (100/169, 59.2%) were related to nausea/vomiting. Diarrhea-related and constipation-related interventions accounted for 10 (5.9%) and 13 (7.7%) of the total interventions, respectively. Most patients (36/52, 69.2%) had a reduction in the severity of their referral diagnosis symptom(s) based on Common Terminology Criteria for Adverse Events grading. CONCLUSION The Michigan Medicine Pharmacist CDTM program allowed pharmacists to independently manage gastrointestinal toxicities of patients with cancer and improved patient symptom severity. The CDTM program has the opportunity to improve quality of care.
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Affiliation(s)
- Morgan J Homan
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Justin H Reid
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Lydia L Benitez
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Anna M Brown
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Shawna Kraft
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Shannon Hough
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Catherine Christen
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - David Frame
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Rachel L McDevitt
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, C427 Med Inn, SPC 5843, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Hough S, McDevitt R, Nachar VR, Kraft S, Brown A, Christen C, Frame D, Smerage JB. Chemotherapy Remote Care Monitoring Program: Integration of SMS Text Patient-Reported Outcomes in the Electronic Health Record and Pharmacist Intervention for Chemotherapy-Induced Nausea and Vomiting. JCO Oncol Pract 2021; 17:e1303-e1310. [PMID: 33534634 DOI: 10.1200/op.20.00639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) is a common cause of unplanned healthcare utilization. The University of Michigan Rogel Cancer Center initiated the chemotherapy remote care monitoring program (CRCMP) to proactively identify patients experiencing CINV and intervene before the need for urgent evaluation. METHODS High-risk patients for CINV are identified by neurokinin-1 (NK-1) antagonist administration, enrolled in the CRCMP, and received a daily text message survey for 7 days after chemotherapy administration to report symptoms. Responses above a set threshold trigger a message to the team pharmacist for intervention. The primary outcome of 14-day unplanned healthcare use was evaluated before and after CRCMP implementation. RESULTS In 8 months, 652 patients received an NK-1 antagonist (2,244 cycles) and 387 patients were enrolled in the CRCMP (59%). Text message response rate was 94%. Clinical pharmacists provided 248 interventions in 121 patient episodes meeting threshold criteria. Fourteen-day unplanned healthcare use was decreased in the CRCMP-enrolled NK-1 episodes (6.68% v 4.53%, P = .02). Admissions were numerically lower for those enrolling in CRCMP when only admissions for nausea were considered (0.63% v 0.35%, P = .33). CONCLUSION The CRCMP allowed for real-time management of patient-reported CINV symptom burden based on patient-reported outcomes (PROs) and an electronic medical record-integrated SMS text questionnaire. Clinical pharmacists were key team members to manage patient symptoms. Enrollment in CRCMP significantly reduced overall unplanned healthcare utilization. Although these changes were numerically small, any reduction in unnecessary care utilizing PROs can contribute to high-value care for patients with cancer.
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Affiliation(s)
- Shannon Hough
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | | | - Shawna Kraft
- University of Michigan Rogel Cancer Center, Ann Arbor, MI.,University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Anna Brown
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | - David Frame
- University of Michigan Rogel Cancer Center, Ann Arbor, MI.,University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Jeffrey B Smerage
- University of Michigan Rogel Cancer Center, Ann Arbor, MI.,Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
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10
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Bazzell BG, Benitez LL, Marini BL, Perissinotti AJ, Phillips TJ, Nachar VR. Evaluating the Role of Novel Oncology Agents: Oncology Stewardship in Relapsed/Refractory Diffuse Large B-Cell Lymphoma. Clin Lymphoma Myeloma Leuk 2021; 21:295-308. [PMID: 33485834 DOI: 10.1016/j.clml.2020.12.018] [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] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
Novel treatment strategies have shifted the treatment landscape for patients with diffuse large B-cell lymphoma, particularly for those with relapsed/refractory disease. However, uncertainty remains regarding the therapeutic value of these novel agents compared to existing salvage chemotherapy regimens. In addition, the high cost associated with these agents puts both patients and health systems at risk of financial toxicity, further complicating their use. The development of clinical pathways incorporating oncology stewardship principles are necessary in order to maximize value-based care. This comprehensive review assesses the efficacy and safety data available for novel treatment options in relapsed/refractory diffuse large B-cell lymphoma and applies stewardship principles to evaluate their optimal place in therapy, with the aim of optimizing safe, effective, and financially responsible patient care.
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Affiliation(s)
- Brian G Bazzell
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Lydia L Benitez
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Bernard L Marini
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Tycel J Phillips
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI.
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11
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Abstract
Cancer-associated venous thromboembolism (VTE) is a common complication of malignancy. Patients with cancer exhibit risk factors for both recurrent VTE and major or minor bleeding. Direct oral anticoagulants (DOACs) are an attractive treatment option; however, there is a lack of consensus among national guidelines for choice between DOACs and LMWH, agent selection, dosing strategy, and duration of anticoagulation. Characteristics of the thrombotic event, the malignancy, the patient, and the anticoagulant must be considered. A systematic search of online databases was performed to identify literature on the management of cancer-associated VTE. Multiple controversies remain surrounding the optimal treatment of cancer-associated VTE.
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Affiliation(s)
- Victoria R Nachar
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Allison J Schepers
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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12
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Tam AH, Schepers AJ, Qin A, Nachar VR. Impact of Extended-Interval Versus Standard Dosing of Zoledronic Acid on Skeletal Events in Non-Small-Cell Lung Cancer and Small-Cell Lung Cancer Patients With Bone Metastases. Ann Pharmacother 2020; 55:697-704. [PMID: 33070623 DOI: 10.1177/1060028020967629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Zoledronic acid every 4 weeks (Q4wk) reduces the incidence of skeletal-related events (SREs) in patients with metastatic lung cancer. Lung cancer patients were excluded from extended-interval dosing trials (every 12 weeks [Q12wk]) that demonstrated noninferiority of the 2 dosing schemes. To date, the optimal dosing of zoledronic acid in metastatic lung cancer remains unknown. OBJECTIVE To determine whether zoledronic acid dosed Q12wk is similar to Q4wk dosing for prevention of SRE in patients with metastatic lung cancer. METHODS A retrospective analysis was performed in patients with non-small-cell lung cancer and small-cell lung cancer with bone metastases who received Q12wk and Q4wk zoledronic acid. The primary outcome was incidence of SRE at 1 year. Secondary analyses included time to first SRE, overall survival (OS), incidence of osteonecrosis of the jaw (ONJ), kidney dysfunction, and hypocalcemia. RESULTS A total of 34 patients received Q12wk and 46 patients received Q4wk zoledronic acid. Incidence of SRE at 1 year (Q12wk, 23.5%, vs Q4wk, 23.9%; 95% CI = -0.184 to 0.192; P = 0.968) and median time to SRE (not reached for either cohort; P = 0.530) did not differ. The Q12wk cohort had longer median OS (24.00 vs 8.97 months; P = 0.022). There were no differences in incidence of ONJ, kidney dysfunction, and hypocalcemia. CONCLUSION AND RELEVANCE This is the first report examining extended-interval dosing of zoledronic acid in metastatic lung cancer. Incidence and time to SRE at 1 year were similar. This extended-interval dosing may be safe and reasonable for patients with lung cancer with bone metastases.
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Affiliation(s)
- Andrew H Tam
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - Angel Qin
- University of Michigan, Ann Arbor, MI, USA
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13
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Reid JH, Marini BL, Nachar VR, Brown AM, Devata S, Perissinotti AJ. Contemporary treatment options for a classical disease: Advanced Hodgkin lymphoma. Crit Rev Oncol Hematol 2020; 148:102897. [PMID: 32109715 DOI: 10.1016/j.critrevonc.2020.102897] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/06/2020] [Accepted: 02/03/2020] [Indexed: 01/12/2023] Open
Abstract
Advanced classical Hodgkin lymphoma (cHL) is a rare lymphoid disease characterized by the presence of Hodgkin and Reed-Sternberg (HRS) cells. Each year, cHL accounts for 0.5% of all new cancer diagnoses and about 80% are diagnosed with advanced stage disease. Given the significant improvement in cure rates, the focus of treatment has shifted towards minimization of acute and long-term toxicities. PET-adapted strategies have largely been adopted as standard of care in the United States in an attempt to balance toxicities with adequate lymphoma control. However, the appropriate upfront chemotherapy regimen (ABVD versus eBEACOPP) remains controversial.
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Affiliation(s)
- Justin H Reid
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, 1540 E. Hospital Drive, CW 7-251B, Ann Arbor, MI 48109, United States
| | - Bernard L Marini
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, 1540 E. Hospital Drive, CW 7-251B, Ann Arbor, MI 48109, United States
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, 1540 E. Hospital Drive, CW 7-251B, Ann Arbor, MI 48109, United States
| | - Anna M Brown
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, 1540 E. Hospital Drive, CW 7-251B, Ann Arbor, MI 48109, United States
| | - Sumana Devata
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, 1540 E. Hospital Drive, CW 7-251B, Ann Arbor, MI 48109, United States.
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Weis TM, Marini BL, Nachar VR, Brown AM, Phillips TJ, Brown J, Wilcox RA, Kaminski MS, Devata S, Perissinotti AJ. Impact of a vincristine dose cap on the incidence of neuropathies with DA-EPOCH-R for the treatment of aggressive lymphomas. Leuk Lymphoma 2019; 61:1126-1132. [DOI: 10.1080/10428194.2019.1703969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Taylor M. Weis
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Bernard L. Marini
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Victoria R. Nachar
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Anna M. Brown
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Tycel J. Phillips
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julia Brown
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Ryan A. Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mark S. Kaminski
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sumana Devata
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anthony J. Perissinotti
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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15
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Robinson AC, Nachar VR. Successful rechallenge of rituximab following severe rituximab-induced acute thrombocytopenia in a patient with splenic marginal zone lymphoma. J Oncol Pharm Pract 2019; 26:1248-1253. [PMID: 31766968 DOI: 10.1177/1078155219890023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/11/2022]
Abstract
Rituximab-induced acute thrombocytopenia (RIAT) is a relatively rare complication of rituximab treatment that has been infrequently reported in a number of patients with malignant lymphoma. Most commonly encountered in mantle cell lymphoma, the extent to which RIAT occurs in splenic marginal zone lymphoma is unknown. In this report, we describe a case of RIAT in a patient with splenic marginal zone lymphoma. Rituximab was safely rechallenged with increased premedications and slowed infusion rate. While the exact mechanism of this phenomenon has yet to be elucidated, diligent monitoring of platelet counts following rituximab infusion can be considered in high-risk patients to avoid potential adverse events. Split dose rituximab for high-risk patients may provide an alternative approach to improve patient safety.
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Affiliation(s)
- Adam C Robinson
- Department of Pharmacy Services, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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16
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Hoylman E, Brown A, Perissinotti AJ, Marini BL, Pianko M, Ye JC, Campagnaro E, Nachar VR. Optimal sequence of daratumumab and elotuzumab in relapsed and refractory multiple myeloma. Leuk Lymphoma 2019; 61:691-698. [PMID: 31739729 DOI: 10.1080/10428194.2019.1688324] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/19/2023]
Abstract
Daratumumab and elotuzumab have demonstrated improvements in overall response rates (ORR) and progression-free survival (PFS) in relapsed/refractory multiple myeloma (RRMM). There is a lack of comparative clinical trials and an even larger lack of consensus on the optimal integration of these novel agents into the treatment paradigm. Clinical outcomes were compared retrospectively in 37 patients who received daratumumab before elotuzumab (dara-first, n = 23) and patients who received elotuzumab before daratumumab (elo-first, n = 14). ORR to the first monoclonal antibody was not different (dara-first 56.5% vs. elo-first 64.3%, p = .641). ORR to the second antibody differed when daratumumab was given second compared to when elotuzumab was given second (64.3% vs. 34.8%, respectively; p = .081). Cumulative PFS for elo-first was significantly longer than dara-first (22.67 months vs. 10.5 months, respectively; p = .001). Response rates to daratumumab may be preserved irrespective of sequence. However, response rates to elotuzumab may diminish with prior daratumumab exposure.
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Affiliation(s)
- Emily Hoylman
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Anna Brown
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Bernard L Marini
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Matthew Pianko
- Department of Internal Medicine, Division of Hematology and Oncology, Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA
| | - Jing Christine Ye
- Department of Internal Medicine, Division of Hematology and Oncology, Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA
| | - Erica Campagnaro
- Department of Internal Medicine, Division of Hematology and Oncology, Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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17
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Weis TM, Perissinotti AJ, Nachar VR, Brown AM, Phillips TJ, Marini BL. Dosing Vincristine in Dose-Adjusted EPOCH-R: To Cap or Not to Cap? J Clin Oncol 2019; 37:2952. [PMID: 31532723 DOI: 10.1200/jco.19.01259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Taylor M Weis
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
| | - Anthony J Perissinotti
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
| | - Victoria R Nachar
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
| | - Anna M Brown
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
| | - Tycel J Phillips
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
| | - Bernard L Marini
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
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18
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Nachar VR, Farris K, Beekman K, Griggs J, Hough S, Mackler E. Clinician Report of Oral Oncolytic Symptoms and Adherence Obtained via a Patient-Reported Outcome Measure (PROM). JCO Clin Cancer Inform 2019; 3:1-6. [PMID: 31100014 DOI: 10.1200/cci.18.00128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient-reported outcome measures (PROMs) for symptom monitoring during cancer therapy have been shown to have a positive impact on outcomes. These findings have primarily been shown for patients receiving intravenous chemotherapy. In addition, there is known discordance between physician reporting of symptoms and patient self-report. This initiative sought to describe patient-reported symptom burden and medication adherence and to indicate the degree of PROM results being discussed with the provider as indicated by documentation in the medical record for patients taking oral oncolytic therapy. METHODS The Michigan Oncology Quality Consortium (MOQC) PROM, which included symptom ratings, medication adherence, and patient confidence in self-management, was completed during outpatient visits and compared with corresponding data documented in the electronic medical record (EMR). RESULTS There were 82 completed PROMs. Approximately half included at least one symptom rated as severe (46%). Sixty-five percent of reported severe symptoms were documented in the EMR. Patient-reported moderate-to-severe pain was most likely to be documented in the EMR (100%), whereas patient-reported moderate-to-severe depression and anxiety were least likely to be documented (21%). Of the total symptoms documented, grading of symptom severity matched that of the patients' own report for 11% of severe symptoms. Adherence to oral oncolytics was excellent for 63% of patients, and patient adherence was documented in 7% of provider notes. CONCLUSION Patients frequently reported moderate-to-severe symptoms, and approximately 40% of patients reported nonadherence. Clinician report (documented in the EMR) of the patient symptom burden, symptom severity, and adherence to oral oncolytic therapy was not consistent with the patients' self-report. Use of a PROM for patients taking oral oncolytics has the opportunity to improve symptom management and medication adherence.
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Affiliation(s)
- Victoria R Nachar
- University of Michigan, Ann Arbor, MI.,University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Karen Farris
- University of Michigan College of Pharmacy, Ann Arbor, MI.,Michigan Oncology Quality Consortium, Ann Arbor, MI
| | | | - Jennifer Griggs
- University of Michigan, Ann Arbor, MI.,Michigan Oncology Quality Consortium, Ann Arbor, MI
| | - Shannon Hough
- University of Michigan, Ann Arbor, MI.,Michigan Oncology Quality Consortium, Ann Arbor, MI
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19
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Vulaj V, Perissinotti AJ, Uebel JR, Nachar VR, Scappaticci GB, Crouch A, Bixby DL, Burke PW, Maillard I, Talpaz M, Marini BL. The FOSSIL Study: FLAG or standard 7+3 induction therapy in secondary acute myeloid leukemia. Leuk Res 2018; 70:91-96. [PMID: 29908418 DOI: 10.1016/j.leukres.2018.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 02/19/2018] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 12/18/2022]
Abstract
Patients with secondary acute myeloid leukemia (sAML) have poor outcomes, with CR/CRi rates of 25-35% with standard 7 + 3 induction chemotherapy, while single center non-comparative analyses suggest promising outcomes with FLAG. We conducted a single-center, retrospective cohort study assessing outcomes in treatment-naïve patients with sAML treated with fludarabine, high-dose cytarabine, and granulocyte colony-stimulating factor (FLAG, n = 40) compared with 7 + 3 (n = 66). Median patient age was 63 years (range: 27-82) in the FLAG group and 60 years (range: 21-76) in the 7 + 3 group (P = 0.968). Patients treated with FLAG achieved higher overall response rates (CR + CRi + MLFS) compared to 7 + 3 (70% vs. 48%, P = 0.043). FLAG was well tolerated, with only one induction death (30-day mortality rate, 3% vs. 8%, P = 0.405) and no cases of cerebellar toxicity. Duration of neutropenia was significantly shorter with FLAG (median 16 vs. 23 days, P < 0.001). Half of the FLAG-treated patients proceeded to consolidative therapy compared with only 27% of those who received 7 + 3 (P = 0.022). Overall survival was comparable between groups (8.5 mos, FLAG vs. 9.1 mos, 7 + 3; P = 0.798). Thus, FLAG may represent a low-cost treatment strategy in sAML that produces higher response rates and promising survival outcomes with minimal treatment-related toxicity. Further studies are required to prospectively compare FLAG to the newly FDA-approved CPX-351 in sAML.
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Affiliation(s)
- Vera Vulaj
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
| | - James R Uebel
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
| | - Gianni B Scappaticci
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
| | - Ashley Crouch
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Dale L Bixby
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Patrick W Burke
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Ivan Maillard
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Moshe Talpaz
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Bernard L Marini
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
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20
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Nachar VR, Perissinotti AJ, Scappaticci GB, Bixby DL, Marini BL. Predictors for requiring re-induction chemotherapy in acute myeloid leukemia patients with residual disease on day 14 bone marrow assessment. Leuk Res 2017; 63:56-61. [DOI: 10.1016/j.leukres.2017.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/05/2017] [Accepted: 10/28/2017] [Indexed: 11/30/2022]
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21
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Nachar VR, Savka FC, McGroty SE, Donovan KA, North RA, Dobson RCJ, Buckley LJ, Hudson AO. Genomic and Biochemical Analysis of the Diaminopimelate and Lysine Biosynthesis Pathway in Verrucomicrobium spinosum: Identification and Partial Characterization of L,L-Diaminopimelate Aminotransferase and UDP-N-Acetylmuramoylalanyl-D-glutamyl-2,6-meso-Diaminopimelate Ligase. Front Microbiol 2012; 3:183. [PMID: 22783236 PMCID: PMC3390587 DOI: 10.3389/fmicb.2012.00183] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 05/02/2012] [Indexed: 11/20/2022] Open
Abstract
The Gram-negative bacterium Verrucomicrobium spinosum has attracted interest in recent years following the sequencing and annotation of its genome. Comparative genomic analysis of V. spinosum using diaminopimelate/lysine metabolic genes from Chlamydia trachomatis suggests that V. spinosum employs the L,L-diaminopimelate aminotransferase (DapL) pathway for diaminopimelate/lysine biosynthesis. The open reading frame corresponding to the putative dapL ortholog was cloned and the recombinant enzyme was shown to possess L,L-diaminopimelate aminotransferase activity in vitro. In vivo analysis using functional complementation confirmed that the dapL ortholog was able to functionally complement an E. coli mutant that confers auxotrophy for diaminopimelate and lysine. In addition to its role in lysine biosynthesis, the intermediate diaminopimelate has an integral role in peptidoglycan biosynthesis. To this end, the UDP-N-acetylmuramoylalanyl-d-glutamyl-2,6-meso-diaminopimelate ligase ortholog was also identified, cloned, and was shown to possess meso-diaminopimelate ligase activity in vivo. The L,L-diaminopimelate aminotransferase pathway has been experimentally confirmed in several bacteria, some of which are deemed pathogenic to animals. Since animals, and particularly humans, lack the genetic machinery for the synthesis of diaminopimelate/lysine de novo, the enzymes involved in this pathway are attractive targets for development of antibiotics. Whether dapL is an essential gene in any bacteria is currently not known. V. spinosum is an excellent candidate to investigate the essentiality of dapL, since the bacterium employs the DapL pathway for lysine and cell wall biosynthesis, is non-pathogenic to humans, facile to grow, and can be genetically manipulated.
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Affiliation(s)
- Victoria R Nachar
- The Thomas H. Gosnell School of Life Sciences, Rochester Institute of Technology Rochester, NY, USA
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