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Al-Kadhimi Z, Pirruccello S, Gul Z, Maness-Harris L, Bhatt VR, Gundabolu K, Yuan J, Lunning M, Bociek G, D'Angelo C, Kallam A, Armitage J, Abdullah K, Hunter A, Mccaslin S, Lyden E, Smith L, Callahan M, Cole K, Hinrichs S, Talmadge J, Vose J. Split dose ATG strategy prevents grade III-IV acute GVHD and is associated with immune surrogates of GVL. Bone Marrow Transplant 2022; 57:1629-1631. [PMID: 35953707 DOI: 10.1038/s41409-022-01772-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Zaid Al-Kadhimi
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Samuel Pirruccello
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Zartash Gul
- Division of Hematology/Oncology, Aurora Health Care, Milwaukee, WI, USA
| | - Lori Maness-Harris
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Vijaya Raj Bhatt
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Krishna Gundabolu
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jane Yuan
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, NY, USA
| | - Matthew Lunning
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gregory Bociek
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher D'Angelo
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Avyakta Kallam
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - James Armitage
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Khansa Abdullah
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Angela Hunter
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sarah Mccaslin
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth Lyden
- Division of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lynnette Smith
- Division of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael Callahan
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kathryn Cole
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Steven Hinrichs
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - James Talmadge
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julie Vose
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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Law JW, Gul Z, Berry A, Thompson MA, Willner C, Vuyyala S, McCracken H, Geverd K, Wolf FM, Brown TD, Kuriakose P. Abstract 6259: Molecular biomarker testing and targeted therapy patterns in patients with acute myelogenous leukemia (AML): A real-world data analysis. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-6259] [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
Background and Objective: Molecular testing and targeted treatments for patients (pts) diagnosed with AML have evolved in recent years. Real-world testing patterns, including next-generation sequencing (NGS), and clinical management of pts with AML were analyzed in 2 large U.S. community health systems.
Methods: Pts >18 years, diagnosed with AML from January 1, 2015 to December 31, 2020, were identified in a database containing clinical and genomic data from integrated community delivery networks. Study end was March 31, 2021, allowing for 3 months minimum follow up. Actionable biomarkers were defined by NCCN guidelines version 3, 2021.
Results: The study included 685 pts, median age of 70 and median follow up of 5.4 months; 55% were male, 73% non-Hispanic White (NHW), 10% non-Hispanic Black (NHB). 69% had de novo AML. Cytogenetic prognostic classification was: 4% favorable; 33% intermediate; 30% adverse; and 33% unknown. 541 (79%) pts, median age of 69, received NGS or single gene/small panel tests. 144 (21%) pts with no testing had a median age of 78. Pts with de novo AML were more likely to be tested compared to secondary AML (84% vs. 67%, p<0.001). No significant difference was found in testing receipt between NHW and NHB pts (82% vs. 76%, p=0.3). 80% of pts received NGS testing in upfront setting, 15% in relapse setting (>30 days after diagnosis), 5% were unknown. 77% of pts diagnosed in 2020 received NGS tests (Table 1). 52/100 (52%) of pts with FLT3 (ITD or TKD) mutation, 5/27 (19%) with IDH1 mutation and 11/44 (25%) with IDH2 mutation received targeted therapy.
Conclusions: Molecular biomarker testing has increased over time with NGS becoming the dominant modality. Testing uptake did not differ by race. Half of pts with FLT3 mutation received targeted therapy, one fifth with IDH1 and one quarter with IDH2 mutations. Future research should explore targeted therapy receipt over time and address gaps in uptake for pts with AML in the community setting.
Table 1. Proportion of patients with molecular biomarker testing by diagnosis year among (n=685) Diagnosis Year 2015(N = 77) 2016(N = 92) 2017(N = 113) 2018(N = 138) 2019(N = 129) 2020(N = 136) Overall(N = 685) NGS testing, n (%) 7 (9%) 17 (18%) 46 (41%) 100 (72%) 100 (78%) 105 (77%) 375 (55%) Other non-NGS molecular biomarker testing only, n (%) 48 (62%) 52 (57%) 38 (34%) 14 (10%) 14 (11%) 0 (0%) 166 (24%) Molecular biomarker testing (NGS and/or other), n (%) 55 (71%) 69 (75%) 84 (74%) 114 (83%) 114 (88%) 105 (77%) 541 (79%) Proportion tested by actionable biomarker, n (%) FLT3-ITD 51 (66%) 64 (70%) 77 (68%) 108 (78%) 106 (82%) 94 (69%) 500 (73%) FLT3-TKD 50 (65%) 63 (68%) 76 (67%) 105 (76%) 106 (82%) 90 (66%) 490 (72%) IDH2 5 (6%) 10 (11%) 34 (30%) 95 (69%) 100 (78%) 102 (75%) 346 (51%) IDH1 5 (6%) 10 (11%) 28 (25%) 91 (66%) 101 (78%) 102 (75%) 337 (49%)
Citation Format: Jeanna Wallenta Law, Zartash Gul, Anna Berry, Michael A. Thompson, Christopher Willner, Sowjanya Vuyyala, Haley McCracken, Katherine Geverd, Frank M. Wolf, Thomas D. Brown, Philip Kuriakose. Molecular biomarker testing and targeted therapy patterns in patients with acute myelogenous leukemia (AML): A real-world data analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6259.
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Affiliation(s)
| | - Zartash Gul
- 2Aurora Cancer Care, Advocate Aurora Health, Milwaukee, WI
| | | | | | | | - Sowjanya Vuyyala
- 3Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | | | | | | | | | - Philip Kuriakose
- 3Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI
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Barreyro L, Sampson AM, Ishikawa C, Hueneman KM, Choi K, Pujato MA, Chutipongtanate S, Wyder M, Haffey WD, O'Brien E, Wunderlich M, Ramesh V, Kolb EM, Meydan C, Neelamraju Y, Bolanos LC, Christie S, Smith MA, Niederkorn M, Muto T, Kesari S, Garrett-Bakelman FE, Bartholdy B, Will B, Weirauch MT, Mulloy JC, Gul Z, Medlin S, Kovall RA, Melnick AM, Perentesis JP, Greis KD, Nurmemmedov E, Seibel WL, Starczynowski DT. Blocking UBE2N abrogates oncogenic immune signaling in acute myeloid leukemia. Sci Transl Med 2022; 14:eabb7695. [PMID: 35263148 DOI: 10.1126/scitranslmed.abb7695] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Dysregulation of innate immune signaling pathways is implicated in various hematologic malignancies. However, these pathways have not been systematically examined in acute myeloid leukemia (AML). We report that AML hematopoietic stem and progenitor cells (HSPCs) exhibit a high frequency of dysregulated innate immune-related and inflammatory pathways, referred to as oncogenic immune signaling states. Through gene expression analyses and functional studies in human AML cell lines and patient-derived samples, we found that the ubiquitin-conjugating enzyme UBE2N is required for leukemic cell function in vitro and in vivo by maintaining oncogenic immune signaling states. It is known that the enzyme function of UBE2N can be inhibited by interfering with thioester formation between ubiquitin and the active site. We performed in silico structure-based and cellular-based screens and identified two related small-molecule inhibitors UC-764864/65 that targeted UBE2N at its active site. Using these small-molecule inhibitors as chemical probes, we further revealed the therapeutic efficacy of interfering with UBE2N function. This resulted in the blocking of ubiquitination of innate immune- and inflammatory-related substrates in human AML cell lines. Inhibition of UBE2N function disrupted oncogenic immune signaling by promoting cell death of leukemic HSPCs while sparing normal HSPCs in vitro. Moreover, baseline oncogenic immune signaling states in leukemic cells derived from discrete subsets of patients with AML exhibited a selective dependency on UBE2N function in vitro and in vivo. Our study reveals that interfering with UBE2N abrogates leukemic HSPC function and underscores the dependency of AML cells on UBE2N-dependent oncogenic immune signaling states.
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Affiliation(s)
- Laura Barreyro
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Avery M Sampson
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chiharu Ishikawa
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathleen M Hueneman
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kwangmin Choi
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mario A Pujato
- Center for Autoimmune Genetics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Somchai Chutipongtanate
- Department of Cancer Biology, University of Cincinnati, Cincinnati, OH, USA.,Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Michael Wyder
- Department of Cancer Biology, University of Cincinnati, Cincinnati, OH, USA
| | - Wendy D Haffey
- Department of Cancer Biology, University of Cincinnati, Cincinnati, OH, USA
| | - Eric O'Brien
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mark Wunderlich
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Vighnesh Ramesh
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ellen M Kolb
- Department of Molecular Genetics, Biochemistry, and Microbiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cem Meydan
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY, USA
| | - Yaseswini Neelamraju
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA
| | - Lyndsey C Bolanos
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susanne Christie
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Molly A Smith
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Cancer Biology, University of Cincinnati, Cincinnati, OH, USA
| | - Madeline Niederkorn
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Cancer Biology, University of Cincinnati, Cincinnati, OH, USA
| | - Tomoya Muto
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Santosh Kesari
- Saint John's Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Francine E Garrett-Bakelman
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA.,Department of Medicine, University of Virginia, Charlottesville, VA, USA.,Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY, USA.,University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Boris Bartholdy
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Britta Will
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthew T Weirauch
- Center for Autoimmune Genetics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Biomedical Informatics and Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - James C Mulloy
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Zartash Gul
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Stephen Medlin
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Rhett A Kovall
- Department of Molecular Genetics, Biochemistry, and Microbiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ari M Melnick
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY, USA
| | - John P Perentesis
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kenneth D Greis
- Department of Cancer Biology, University of Cincinnati, Cincinnati, OH, USA
| | - Elmar Nurmemmedov
- Saint John's Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - William L Seibel
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel T Starczynowski
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Cancer Biology, University of Cincinnati, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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Ohanian M, Cancelas JA, Davenport R, Pullarkat V, Hervig T, Broome C, Marek K, Kelly M, Gul Z, Rugg N, Nestheide S, Kinne B, Szczepiorkowski Z, Kantarjian H, Pehta J, Biehl R, Yu A, Aung F, Antebi B, Fitzpatrick GM. Freeze-dried platelets are a promising alternative in bleeding thrombocytopenic patients with hematological malignancies. Am J Hematol 2022; 97:256-266. [PMID: 34748664 DOI: 10.1002/ajh.26403] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
Thrombosomes are trehalose-stabilized, freeze-dried group O platelets with a 3-year shelf life. They can be stockpiled, rapidly reconstituted, and infused regardless of the recipient's blood type. Thrombosomes thus represent a potential alternative platelet transfusion strategy. The present study assessed the safety and potential early signals of efficacy of Thrombosomes in bleeding thrombocytopenic patients. We performed an open-label, phase 1 study of single doses of allogeneic Thrombosomes at three dose levels in three cohorts, each consisting of eight patients who had hematologic malignancies, thrombocytopenia, and bleeding. Adverse events, dose-limiting toxicities (DLTs), World Health Organization (WHO) bleeding scores, and hematology values were assessed. No DLTs were reported. The median age was 59 years (24-71). Most patients had AML (58%) or ALL (29%), followed by MDS (8%) and myeloproliferative neoplasm (4%). The WHO scores of 22 patients who were actively bleeding at a total of 27 sites at baseline either improved (n = 17 [63%]) or stabilized (n = 10 [37%]) through day 6. Twenty-four hours after infusion, 12 patients (50%) had a clinically significant platelet count increase. Of eight patients who received no platelet transfusions for 6 days after Thrombosomes infusion, 5 had a clinically significant increase in platelet count of ≥5000 platelets/μL and 2 had platelet count normalization. Thrombosomes doses up to 3.78 × 108 particles/kg demonstrated safety in 24 bleeding, thrombocytopenic patients with hematological malignancies. Thrombosomes may represent an alternative to conventional platelets to treat bleeding. A phase 2 clinical trial in a similar patient population is underway.
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Affiliation(s)
- Maro Ohanian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | | | - Vinod Pullarkat
- City of Hope Comprehensive Cancer Center Duarte California USA
| | - Tor Hervig
- Haukeland Universitetssjukehus Bergen Norway
| | - Catherine Broome
- MedStar Georgetown University Hospital Washington District of Columbia USA
| | - Kelly Marek
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Mary Kelly
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Zartash Gul
- Division of Hematology/Oncology, Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Neeta Rugg
- Hoxworth Blood Center Cincinnati Ohio USA
| | | | - Bridget Kinne
- Division of Hematology/Oncology, Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati Ohio USA
| | | | - Hagop Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Joan Pehta
- The Alpha Bio Group New Canaan Connecticut USA
| | - Ruth Biehl
- Cellphire Therapeutics Rockville Maryland USA
| | - Anna Yu
- Cellphire Therapeutics Rockville Maryland USA
| | - Fleur Aung
- Department of Transfusion Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Ben Antebi
- Cellphire Therapeutics Rockville Maryland USA
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Sheikh MA, Toledano M, Ahmed S, Gul Z, Hashmi SK. Noninfectious neurologic complications of hematopoietic cell transplantation: A systematic review. Hematol Oncol Stem Cell Ther 2020; 14:87-94. [PMID: 32516577 DOI: 10.1016/j.hemonc.2020.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/01/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE/BACKGROUND Neurological complications occur at a high frequency after hematopoietic cell transplantation (HCT). However, an absence is noted in the published literature as regards the quantification of the exact burden and the outcomes thereof. In this systematic review, we endeavored to detail if the recipients of HCT developed any noninfectious neurological events/complications. METHODS According to the PICO criteria, medical literature was searched. Complications that were evaluated included: stroke, peripheral neuropathy, myasthenia gravis, seizures, and posterior reversible encephalopathy syndrome. After strictly defining relevant variables and parameters, data from 173 eligible articles were then extracted accordingly, from the full text for each, for quantitative analysis; additionally, two American Society of Hematology conference abstracts were also subject to data extraction. RESULTS As is evident from the results of the data analysis, an increased frequency of these complications was seen in the HCT recipient population in comparison to the general population. The relative risk ranged from 1.33× to 142× depending on the complication studied. CONCLUSION These findings demonstrate that the recipients of HCT had a significantly higher risk of neurological complications and that their early recognition can enhance the monitoring of HCT survivors for the early developmental signs of neurological toxicity. This would facilitate timely interventions, thus ensuring a better quality of life.
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Affiliation(s)
| | | | - Sairah Ahmed
- Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zartash Gul
- Department of Hematology/Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Shahrukh K Hashmi
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Muto T, Walker CS, Choi K, Hueneman K, Smith MA, Gul Z, Garcia-Manero G, Ma A, Zheng Y, Starczynowski DT. Adaptive response to inflammation contributes to sustained myelopoiesis and confers a competitive advantage in myelodysplastic syndrome HSCs. Nat Immunol 2020; 21:535-545. [PMID: 32313245 DOI: 10.1038/s41590-020-0663-z] [Citation(s) in RCA: 84] [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] [Received: 11/11/2019] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
Despite evidence of chronic inflammation in myelodysplastic syndrome (MDS) and cell-intrinsic dysregulation of Toll-like receptor (TLR) signaling in MDS hematopoietic stem and progenitor cells (HSPCs), the mechanisms responsible for the competitive advantage of MDS HSPCs in an inflammatory milieu over normal HSPCs remain poorly defined. Here, we found that chronic inflammation was a determinant for the competitive advantage of MDS HSPCs and for disease progression. The cell-intrinsic response of MDS HSPCs, which involves signaling through the noncanonical NF-κB pathway, protected these cells from chronic inflammation as compared to normal HSPCs. In response to inflammation, MDS HSPCs switched from canonical to noncanonical NF-κB signaling, a process that was dependent on TLR-TRAF6-mediated activation of A20. The competitive advantage of TLR-TRAF6-primed HSPCs could be restored by deletion of A20 or inhibition of the noncanonical NF-κB pathway. These findings uncover the mechanistic basis for the clonal dominance of MDS HSPCs and indicate that interfering with noncanonical NF-κB signaling could prevent MDS progression.
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Affiliation(s)
- Tomoya Muto
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Callum S Walker
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kwangmin Choi
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathleen Hueneman
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Molly A Smith
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Zartash Gul
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Averil Ma
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yi Zheng
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel T Starczynowski
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Cancer Biology, University of Cincinnati, Cincinnati, OH, USA.
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7
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Pinkard SL, Gul Z, Medlin S. Quality Process Improvement: The Impact of Recipient Selection & Evaluation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.163] [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: 11/30/2022]
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8
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Frondorf M, Brummer J, Gul Z, Leemhuis T. TCR α/β+ T cell and CD19+ B cell depletion of HPC apheresis products utilizing CliniMACS. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bal S, Velarde AM, Girnius S, Gul Z, Latif T, Medlin S. Strongyloidiasis in the Immunocompromised—Should We Screen in Ohio? Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.478] [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: 11/30/2022]
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10
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Saeed H, Yalamanchi S, Liu M, Van Meter E, Gul Z, Monohan G, Howard D, Hildebrandt GC, Herzig R. Age adjusted hematopoietic stem cell transplant comorbidity index predicts survival in a T-cell depleted cohort. Hematol Oncol Stem Cell Ther 2018; 11:90-95. [PMID: 29398592 DOI: 10.1016/j.hemonc.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/04/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Allogeneic hematopoietic stem cell transplant (HCT) continues to evolve with the treatment in higher risk patient population. This practice mandates stringent update and validation of risk stratification prior to undergoing such a complex and potentially fatal procedure. We examined the adoption of the new comorbidity index (HCT-CI/Age) proposed by the Seattle group after the addition of age variable and compared it to the pre-transplant assessment of mortality (PAM) that already incorporates age as part of its evaluation criteria. METHODS A retrospective analysis of adult patients who underwent HCT at our institution from January 2010 through August 2014 was performed. Kaplan-Meier's curve, log-rank tests, Cox model and Pearson correlation was used in the analysis. RESULTS Of the 114 patients that underwent allogeneic transplant in our institution, 75.4% were ≥40 years old. More than 58% had a DLCO ≤80%. Although scores were positively correlated (correlation coefficient 0.43, p < 0.001), HCT-CI/Age more accurately predicted 2-year overall survival (OS) and non-relapse mortality (NRM) in patients with lower (0-4) and higher (5-7) scores (52% and 36% versus 24% and 76%, p = 0.004, 0.003 respectively). PAM score did not reach statistical significance for difference in OS nor NRM between the low (<24) and high-risk (≥24) groups (p = 0.19 for both). CONCLUSIONS Despite our small sample population, HCT-CI/Age was more discriminative to identify patients with poor outcome that might benefit from intensified management strategies or other therapeutic approaches rather than allogeneic HCT.
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Affiliation(s)
- Hayder Saeed
- Division of Hematology and Blood and Marrow Transplant, Markey Cancer Center, University of Kentucky, United States.
| | - Swati Yalamanchi
- Division of Hematology and Blood and Marrow Transplant, Markey Cancer Center, University of Kentucky, United States
| | - Meng Liu
- Biostatistics and Bioinformatics Shared Resources, Markey Cancer Center, University of Kentucky, United States
| | - Emily Van Meter
- Biostatistics and Bioinformatics Shared Resources, Markey Cancer Center, University of Kentucky, United States
| | - Zartash Gul
- Division of Hematology and Oncology, University of Cincinnati, United States
| | - Gregory Monohan
- Division of Hematology and Blood and Marrow Transplant, Markey Cancer Center, University of Kentucky, United States
| | - Dianna Howard
- Hematology and Oncology, Wake Forest Comprehensive Cancer Center, Winston Salem, NC, United States
| | - Gerhard C Hildebrandt
- Division of Hematology and Blood and Marrow Transplant, Markey Cancer Center, University of Kentucky, United States
| | - Roger Herzig
- Division of Hematology and Blood and Marrow Transplant, Markey Cancer Center, University of Kentucky, United States
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Abstract
A mathematical model for avian influenza with optimal control strategies is presented as a system of discrete time delay differential equations (DDEs) and its important mathematical features are analyzed. In alignment to manage this, we develop an optimally controlled pandemic model of avian influenza and insert a time delay with exponential factor. Then we apply two controlled functions in the form of biosecurity of poultry and the education campaign against avian influenza to control the disperse of the disease. Our optimal control strategies will minimize the number of contaminated humans and contaminated birds. We also derive the basic reproduction number to examine the dynamical behavior of the model and demonstrate the existence of the controlled system. For the justification of our work, we present numerical simulations.
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Affiliation(s)
- U. Roman
- Department of Mathematics, Bacha Khan University, Charsadda, Khyber Pakhtunkhwa, Pakistan
| | - Z. Gul
- Department of Mathematics, University of Malakand, Chakdara Dir(Lower), Khyber Pakhtunkhwa, Pakistan
| | - I. Saeed
- Department of Mathematics, Abdul Wali Khan University, Mardan, Khyber Pakhtunkhwa, Pakistan
| | - U. Hakeem
- Department of Mathematics, Abdul Wali Khan University, Mardan, Khyber Pakhtunkhwa, Pakistan
| | - S. Shafie
- Department of Mathematical Sciences, Universiti Teknologi, Johor Bahru, Malaysia
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Hilal T, Slone S, Peterson S, Bodine C, Gul Z. Cytomegalovirus reactivation is associated with a lower rate of early relapse in myeloid malignancies independent of in-vivo T cell depletion strategy. Leuk Res 2017; 57:37-44. [PMID: 28279876 DOI: 10.1016/j.leukres.2017.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/22/2017] [Accepted: 02/26/2017] [Indexed: 11/19/2022]
Abstract
The association between cytomegalovirus (CMV) reactivation and relapse risk has not been evaluated in relation to T cell depletion strategies. We evaluated 93 patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) and analyzed the association between T cell depletion strategies with the cumulative incidence of relapse and CMV reactivation. A total of 33% of patients who received ATG vs. 34% who received alemtuzumab developed CMV reactivation. The cumulative incidence of relapse was 3% at 1year and 20% at 3 years in patients with CMV reactivation vs. 30% at 1year and 38% at 3 years in patients without CMV reactivation (p=0.02). When analyzed separately, this effect persisted in the myeloid, but not the lymphoid group. There was a numerical trend towards increased non-relapse mortality (NRM) in patients with CMV reactivation, especially in the myeloid group. The choice of T cell depleting agent and the rate of CMV reactivation were not associated with different overall survival (OS) rates. These results suggest that the choice of T cell depletion strategy may have similar effects on rates of CMV reactivation, disease relapse, and survival. Further studies examining these variables in patients not exposed to in-vivo T cell depleting agents may be of interest.
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Affiliation(s)
- Talal Hilal
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States; Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, United States.
| | - Stacey Slone
- Biostatistics Shared Resource Facility, University of Kentucky Markey Cancer Center, Lexington, KY, United States
| | - Shawn Peterson
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States
| | - Charles Bodine
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States
| | - Zartash Gul
- Division of Hematology and Blood and Marrow Transplant, University of Kentucky Markey Cancer Center, Lexington, KY, United States; Division of Hematology, University of Cincinnati Cancer Center, Cincinnati, OH, United States
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13
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Khan MW, Hadley T, Kesler M, Gul Z. Immunoglobulin G4-related disease: a rare disease with an unusual presentation. Clin Case Rep 2016; 4:657-60. [PMID: 27386122 PMCID: PMC4929799 DOI: 10.1002/ccr3.583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/18/2016] [Revised: 04/01/2016] [Accepted: 04/18/2016] [Indexed: 12/24/2022] Open
Abstract
IgG4‐RD can also present in the skeletal muscle, mimicking several other diseases. It is unusual for this relatively new classification of diseases to present in the muscles and can be mistakenly diagnosed as other autoimmune diseases rendering a delay in the appropriate management and progression of the disease.
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Affiliation(s)
- Muhammad Waqas Khan
- Department of Internal medicine Division of Hematology/Bone Marrow Transplantation University of Kentucky Lexington Kentucky
| | - Terrance Hadley
- Hematology/Oncology Department Norton Healthcare Norton Cancer Institute Louisville Kentucky
| | - Melissa Kesler
- Department of Hematopathology, Pathology and Laboratory Medicine University of Kentucky Lexington Kentucky
| | - Zartash Gul
- Department of Internal medicine Division of Hematology/Bone Marrow Transplantation University of Kentucky Lexington Kentucky
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14
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Khan MW, Gul Z. Blinatumomab may induce graft versus host leukemia in patients with pre-B ALL relapsing after hematopoietic stem cell transplant. Clin Case Rep 2016; 4:743-6. [PMID: 27525074 PMCID: PMC4974418 DOI: 10.1002/ccr3.604] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/26/2015] [Revised: 04/01/2016] [Accepted: 05/22/2016] [Indexed: 01/01/2023] Open
Abstract
Blinatumomab, a bispecific T-cell engager monoclonal antibody used to manage Philadelphia chromosome-negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL) can be used to treat patients by inducing graft versus leukemia reaction post allogeneic hematopoietic stem cell transplantation, a feature which it was post allogeneic bone marrow transplantation, a feature which this drug was not aimed to do.
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Affiliation(s)
- Muhammad Waqas Khan
- Department of Internal medicine Division of Hematology/Bone Marrow Transplantation University of Kentucky Lexington Kentucky
| | - Zartash Gul
- Department of Internal medicine Division of Hematology/Bone Marrow Transplantation University of Kentucky Lexington Kentucky
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15
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Hilal T, Peterson S, Bodine C, Slone SA, Hildebrandt G, Gul Z. Evaluation of cytomegalovirus (CMV) reactivation, relapse, and survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT) using two T cell depletion strategies. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Talal Hilal
- Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Shawn Peterson
- Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Charles Bodine
- Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Stacey A. Slone
- Biostatistical Core, Markey Cancer Center, University of Kentucky, Lexington, KY
| | | | - Zartash Gul
- Markey Cancer Center, University of Kentucky, Lexington, KY
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16
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Johnson L, Bylund J, Strup S, Howard D, Gul Z, Khan MW, Venkatesh R. Concomitant Renal Cell Carcinoma and Hematologic Malignancy in Immunosuppressed Patients. Am J Med Sci 2016; 351:480-4. [PMID: 27140706 DOI: 10.1016/j.amjms.2016.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Treatment of a renal mass in patients with hematologic malignancy or on immunosuppression can be complex and is not well defined. Surgical excision or thermal ablation of renal mass is generally recommended in view of concern for tumor progression in immunosuppressed patients. We report our management decision experience in patients and literature review on concomitant renal and hematologic malignancy. MATERIALS AND METHODS A retrospective medical record review of patients with renal cell carcinoma (RCC) and a hematologic malignancy over 3 years at our University Hospital was performed. Data were collected including patient׳s demographics, renal tumor and hematologic malignancy characteristics (stage, pathologic subtype, time of diagnosis, treatment type and prognosis). Surgical and medical management of each malignancy was reviewed and perioperative and overall outcomes are reported. RESULTS In total, 6 patients were identified with RCC and a hematologic malignancy of which 4 were on immunosuppressive therapy. A total of 5 patients had leukemia and 1 patient had multiple myeloma. Most kidney tumors were stage I, 83%; and 80% were Fuhrman grade II. There was equal distribution of clear cell and papillary-type RCC. All but 1 patient had undergone nephron-sparing surgery. Overall, 50% of our patients died within 1 year after renal surgery for pT1a tumors from causes that are unrelated to renal cancer. CONCLUSIONS Our small cohort showed significant mortality in patients with hematologic malignancy on immunosuppression, who had their renal mass treated with surgical excision or thermal ablation. However, this mortality was not secondary to surgical procedure itself. The prognosis of the hematologic malignancy might dictate the management of RCC.
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MESH Headings
- Aged
- Carcinoma, Renal Cell/etiology
- Carcinoma, Renal Cell/immunology
- Carcinoma, Renal Cell/therapy
- Female
- Humans
- Immunocompromised Host
- Kentucky
- Kidney Neoplasms/etiology
- Kidney Neoplasms/immunology
- Kidney Neoplasms/therapy
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/therapy
- Lymphoproliferative Disorders/etiology
- Lymphoproliferative Disorders/immunology
- Lymphoproliferative Disorders/therapy
- Male
- Middle Aged
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/immunology
- Neoplasms, Second Primary/therapy
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- Lewis Johnson
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Jason Bylund
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Stephen Strup
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Dianne Howard
- Division of Hematology Blood & Marrow Transplantation, University of Kentucky, Lexington, Kentucky
| | - Zartash Gul
- Division of Hematology Blood & Marrow Transplantation, University of Kentucky, Lexington, Kentucky.
| | - Muhammad Waqas Khan
- Division of Hematology Blood & Marrow Transplantation, University of Kentucky, Lexington, Kentucky
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17
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Hilal T, Gul Z. Exploring the possibilities: airspace disease in the postallogeneic haematopoietic stem cell transplant period. BMJ Case Rep 2015; 2015:bcr-2015-211922. [PMID: 26516247 DOI: 10.1136/bcr-2015-211922] [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: 11/04/2022] Open
Abstract
A 50-year-old man with a history of myelodysplastic syndrome status postallogeneic haematopoietic stem cell transplantation (HSCT) in July 2013 presented in January 2014 with a 6-week history of worsening shortness of breath and dry cough. Chest imaging revealed scattered groundglass opacities in the upper lobes bilaterally and two areas of focal consolidation on the left side. Bronchoscopy with bronchoalveolar lavage grew methicillin-resistant Staphylococcus aureus and the patient was treated with a prolonged course of vancomycin without improvement in symptoms or oxygenation. Image-guided core biopsy of an area of consolidation revealed histological findings of acute fibrinous and organising pneumonia. The patient was diagnosed with what appeared to be a manifestation of chronic graft-versus-host disease of the lung and started on high-dose corticosteroids with resultant improvement in symptoms. The response was short-lived and the patient expired 2 months later.
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Affiliation(s)
- Talal Hilal
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Zartash Gul
- Division of Hematology, University of Kentucky, Lexington, Kentucky, USA
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18
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Saeed H, Woods RR, Lester J, Herzig R, Gul Z, Monohan G. Evaluating the optimal serum ferritin level to identify hemophagocytic lymphohistiocytosis in the critical care setting. Int J Hematol 2015; 102:195-9. [PMID: 25997871 DOI: 10.1007/s12185-015-1813-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 12/11/2022]
Abstract
Ferritin is known to be involved in numerous physiological roles, such as iron storage, as well as various pathological conditions and in generalized inflammatory states. Hyperferritinemia is also encountered in the setting of hemophagocytic lymphohistiocytosis (HLH). Current diagnostic criteria exist to define HLH based on several clinical and biochemical markers, including the serum ferritin level. In this study, we retrospectively evaluated the value of ferritin >500 ng/mL in diagnosing HLH in 344 consecutive patients admitted to the medical intensive care unit at our hospital. Nine cases of HLH were identified. Comparison of the HLH with the non-HLH group showed that their maximum median serum ferritin level was 25,652 (range 1977-100,727 ng/mL) versus 1180 (503-85,168 ng/mL) (P < 0.001), platelets were 30 (5-92 × 10(3)/μL) versus 113 (0-507 × 10(3)/μL) (P < 0.001), absolute neutrophil counts were 2.56 (0.02-23.7 × 10(3)/μL) versus 7.7 (0.01-82.7 × 10(3)/μL) (P = 0.002), and triglycerides were 255 (156-394 mg/dL) versus 127 (17-624 mg/dL) (P = 0.002), respectively. Using a receiver operating characteristic curve, the optimal maximum serum ferritin level for the diagnosis of HLH was 3951 ng/mL, exceeding the current diagnostic cutoff set forth in the HLH-2004 guidelines. These data suggest that a higher cutoff value of ferritin level may have improved utility in the diagnosis of secondary HLH in the critical care setting.
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Affiliation(s)
- Hayder Saeed
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA,
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19
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Saeed HM, Yalamanchi S, Liu M, (Van Meter) Dressler E, Haider SN, Gul Z, Monohan GP, Herzig R. Comparison of common pretransplant assessment scores: A single institution experience. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e18004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Meng Liu
- University of Kentucky Markey Cancer Center, Lexington, KY
| | | | | | - Zartash Gul
- University of Kentucky Markey Cancer Center, Lexington, KY
| | | | - Roger Herzig
- University of Kentucky Markey Cancer Center, Lexington, KY
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20
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Shah N, Callander N, Ganguly S, Gul Z, Hamadani M, Costa L, Sengsayadeth S, Abidi M, Hari P, Mohty M, Chen YB, Koreth J, Landau H, Lazarus H, Leather H, Majhail N, Nath R, Osman K, Perales MA, Schriber J, Shaughnessy P, Vesole D, Vij R, Wingard J, Giralt S, Savani BN. Hematopoietic Stem Cell Transplantation for Multiple Myeloma: Guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2015; 21:1155-66. [PMID: 25769794 DOI: 10.1016/j.bbmt.2015.03.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 01/28/2023]
Abstract
Therapeutic strategies for multiple myeloma (MM) have changed dramatically over the past decade. Thus, the role of hematopoietic stem cell transplantation (HCT) must be considered in the context of this evolution. In this evidence-based review, we have critically analyzed the data from the most recent clinical trials to better understand how to incorporate HCT and when HCT is indicated. We have provided our recommendations based on strength of evidence with the knowledge that ongoing clinical trials make this a dynamic field. Within this document, we discuss the decision to proceed with autologous HCT, factors to consider before proceeding to HCT, the role of tandem autologous HCT, post-HCT maintenance therapy, and the role of allogeneic HCT for patients with MM.
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Affiliation(s)
- Nina Shah
- MD Anderson Cancer Center, Houston, Texas.
| | - Natalie Callander
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Luciano Costa
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Parameswaran Hari
- Center for International Blood and Marrow Transplant Research and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohamad Mohty
- Hopital Saint-Antoine, APHP, Paris, France; Université Pierre & Marie Curie, Paris, France, INSERM, UMRs 938, Paris, France
| | - Yi-Bin Chen
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - John Koreth
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Heather Landau
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Rajneesh Nath
- University of Massachusetts, Worcester, Massachusetts
| | - Keren Osman
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jeffrey Schriber
- Cancer Transplant Institute at Scottsdale Healthcare, Scottsdale, Arizona
| | | | - David Vesole
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey
| | - Ravi Vij
- Washington University School of Medicine, St. Louis, Missouri
| | - John Wingard
- University of Florida College of Medicine, Gainesville, Florida
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennesee
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21
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Gul Z, Bashir Q, Cremer M, Yusuf SW, Gunaydin H, Arora S, Slone S, Nieto Y, Sherwani N, Parmar S, Shah N, Dinh YT, Hosing CM, Popat UR, Kebriaei P, Shpall EJ, Giralt SA, Champlin RE, Qazilbash MH. Short-term cardiac toxicity of autologous hematopoietic stem cell transplant for multiple myeloma. Leuk Lymphoma 2015; 56:533-5. [PMID: 24882259 DOI: 10.3109/10428194.2014.926346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Zartash Gul
- Department of Hematology/BMT, Markey Cancer Center, University of Kentucky Medical Center , Lexington, KY , USA
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22
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Gul Z, Van Meter E, Abidi M, Ditah I, Abdul-Hussein M, Deol A, Ayash L, Lum LG, Waller EK, Ratanatharathorn V, Uberti J, Al-Kadhimi Z. Low blood lymphocyte count at 30 days post transplant predicts worse acute GVHD and survival but not relapse in a large retrospective cohort. Bone Marrow Transplant 2015; 50:432-7. [DOI: 10.1038/bmt.2014.284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/18/2014] [Accepted: 08/19/2014] [Indexed: 11/09/2022]
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23
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Al-Kadhimi Z, Gul Z, Chen W, Smith D, Abidi M, Deol A, Ayash L, Lum L, Waller EK, Ratanatharathorn V, Uberti J. High incidence of severe acute graft-versus-host disease with tacrolimus and mycophenolate mofetil in a large cohort of related and unrelated allogeneic transplantation patients. Biol Blood Marrow Transplant 2014; 20:979-85. [PMID: 24709007 DOI: 10.1016/j.bbmt.2014.03.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 12/19/2013] [Accepted: 03/16/2014] [Indexed: 01/01/2023]
Abstract
Both acute and chronic graft-versus-host disease (GVHD) are major causes of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT). The optimal pharmacological regimen for GVHD prophylaxis is unclear, but combinations of a calcineurin inhibitor (cyclosporin or tacrolimus [Tac]) and an antimetabolite (methotrexate or mycophenolate mofetil [MMF]) are typically used. We retrospectively evaluated the clinical outcomes of 414 consecutive patients who underwent AHSCT from sibling (SD) or unrelated donors (UD) with Tac/MMF combination, between January 2005 and August 2010. The median follow-up was 60 months. Less than one third of the patients received a reduced-intensity chemoregimen. The incidence of grades III and IV acute GVHD was 22.3% and 36.5% in SD and UD groups, respectively (P = .0007). The incidence of chronic GVHD was 47.1% and 52.7% in the SD and UD groups, respectively. Nonrelapse mortality (NRM) at 60 months was 33.3% and 46.5% in the SD and UD groups, respectively (P = .0016). The incidence of relapse was 22.4% for UD and 28.8% for SD. Five-year overall survival was 43% and 34% in the SD and UD groups, respectively (P = .0183). GVHD was the leading cause of death for the entire cohort. Multivariable analysis showed that 8/8 HLA match, patient's age < 60, and low-risk disease were associated with better survival. The use of Tac/MMF for GVHD prophylaxis was associated with a relatively high incidence of severe acute GVHD and NRM in AHSCT from sibling and unrelated donors.
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Affiliation(s)
- Zaid Al-Kadhimi
- Department of Hematology and Medical Oncology, Emory University and Winship Cancer Center, Atlanta, Georgia.
| | - Zartash Gul
- Division of Hematology/BMT, Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Wei Chen
- Biostatistics Core, Department of Oncology, Wayne State University/Karmanos Cancer Center, Detroit, Michigan
| | - Daryn Smith
- Biostatistics Core, Department of Oncology, Wayne State University/Karmanos Cancer Center, Detroit, Michigan
| | - Muneer Abidi
- Blood and Marrow Program, Department of Oncology, Wayne State University/Karmanos Cancer Center, Detroit, Michigan
| | - Abhinav Deol
- Blood and Marrow Program, Department of Oncology, Wayne State University/Karmanos Cancer Center, Detroit, Michigan
| | - Lois Ayash
- Blood and Marrow Program, Department of Oncology, Wayne State University/Karmanos Cancer Center, Detroit, Michigan
| | - Lawrence Lum
- Blood and Marrow Program, Department of Oncology, Wayne State University/Karmanos Cancer Center, Detroit, Michigan
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Emory University and Winship Cancer Center, Atlanta, Georgia
| | - Voravit Ratanatharathorn
- Blood and Marrow Program, Department of Oncology, Wayne State University/Karmanos Cancer Center, Detroit, Michigan
| | - Joseph Uberti
- Blood and Marrow Program, Department of Oncology, Wayne State University/Karmanos Cancer Center, Detroit, Michigan
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24
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Gul Z, Arora S, Lawson A, Weiss HL. Intravenous(IV) Busulfan (BU) Pharmacokinetics Using Busulfan and Fludarabine (Flu) Conditioning in Institutions Where the Capability of Doing Pharmacokinetics Is Not Present. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.130] [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: 10/25/2022]
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25
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Bailey SD, Gul Z, Slone SA, Van Meter EM, Lawson A, Raufi A, Hayslip JW, Monohan G, Howard DS, McDonagh KT, Alkadhimi Z. Hypomethylating agents as first-line therapy in acute myeloid leukemia (AML). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7084 Background: Hypomethylating agents are used in older AML patients (pts) who are not considered candidates for standard induction therapy. However, data regarding their efficacy remains unclear. Methods: We retrospectively evaluated a cohort of 24 consecutive AML pts who were placed on hypomethylation therapy at diagnosis between October 2010 and June 2012 at Markey Cancer Center. Results: Baseline characteristics of the patients are described in table 1. Response rate (CR+PR) was 45.8%. Median number of infections were 1 (8 pts), 2 (5 pts), 3 (4 pts).Median hospital admissions required were 1 (10 pts), 2 (4 pts), 3 (5 pts), 4 or greater (2 pts). Average length of hospital stay was 10.3 days (0-37 days). Median units of packed red cell and platelet transfusions were 10 and 11 units (Range=0-64 and 0-78) respectively. After a median follow up of 145.5 days, 13 pts had died. Cause of death was AML (6 pts), infection and end organ failure (7pts).Median overall survival (OS) was 9.7 months (95%CI: 3.2-16.5 months). On multivariate analysis, blast count less than 30% was borderline significantly associated with better OS (P=0.05). However after addition of average hospital stay in the model only age (HR=1.3, CI=1.06- 1.67), gender (HR=11.5, CI=1.2, 110.5), and average hospital stay were significantly associated with OS (HR=1.2, CI = 1.04- 1.32). Conclusions: In this cohort of pts the median OS was 9.7 months. Older pts and those with longer average hospital stay had a higher mortality. Better selection of pts in a larger cohort who are likely to gain more benefit from these agents may impact outcomes. [Table: see text]
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Affiliation(s)
| | | | - Stacey A. Slone
- Biostatistical Core, University of Kentucky-Markey Cancer Center, Lexington, KY
| | | | | | | | | | | | | | | | - Zaid Alkadhimi
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
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26
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Gul Z, Jain A, Slone SA, Raufi A, Van Meter EM, Lawson A, Hayslip JW, Monohan G, Howard DS, McDonagh KT, Alkadhimi Z. Cytarabine plus mitoxantrone versus cytarabine plus clofarabine as second-line therapy in AML. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e18001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18001 Background: There are no comparative studies that can provide guidance about the choice of second line therapy in AML patients (pts). Methods: We retrospectively evaluated 30 consecutive pts who underwent reinduction chemotherapy for AML with mitoxantrone and cytarabine (ACM) or cytarabine and clofarabine (ACC). Results: Baseline characteristics of the pts are described in the Table. Ten pts achieved remission after initial induction therapy in ACM group and 4 pts in ACC group (P=0.71). Median length of remission was 314 days (d) (81-874 d) in ACM group and 178.5 d (57-232 d) in ACC group (P=0.13).After reinduction in ACM and ACC groups 9 and 3 patients achieved remission respectively (P=0.4).One pt in each group underwent allogeneic stem cell transplant. After a median follow-up of 11.2 m (ACM) and 10.5m (ACC), 9 and 6 pts had died in ACM and ACC groups respectively. Causes of death were progression (ACM=2pts, ACC= 1pt), end organ failure (3 pts each) and unknown (ACM=4pts, ACC=2 pts). Median Overall survival (OS) was 18.4 months (m) in ACM and 13.1 m in ACC group (P=0.49). After reinduction therapy OS was 8.3 and 6.9 m in ACM and ACC groups (P=0.72). In our patient cohort we did not find any baseline characteristics that were associated with OS or achievement of remission after reinduction therapy. Conclusions: In our pt cohort both ACM and ACC regimens demonstrated the ability to induce remission as a possible bridging strategy to allogeniec stem cell transplant. Larger studies are needed to compare these two regimens as well as evaluate any baseline characteristics which correlate with OS or achievement of remission. [Table: see text]
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Affiliation(s)
| | | | - Stacey A. Slone
- Biostatistical Core, University of Kentucky-Markey Cancer Center, Lexington, KY
| | | | | | | | | | | | | | | | - Zaid Alkadhimi
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
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Al-Kadhimi Z, Gul Z, Van Meter E, Abidi MH, Deol A, Ayash LJ, Lum L, Ratanatharathorn V, Uberti J. Lower Lymphocyte Count At Day 30 Predicts Worse Overall Survival with Tacrolimus and Mycophenophelate Mofetil Use for Gvhd Prophylaxis: A Large Retrospective Analysis. Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gul Z, Bailey SD, Van Meter E, Al-Kadhimi Z, Lawson A, Hayslip J, Monahan GP, Shelton B, McDonagh KT, Howard D. Lymphocyte Count Above 300 X 106/Ml 90 Days Post Transplant Predicts Better Overall Survival After Alemtuzumab for Unrelated Donor Stem Cell Transplant. Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.217] [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: 11/15/2022]
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Al-Kadhimi Z, Gul Z, Rodriguez R, Chen W, Smith D, Mitchell A, Abidi M, Ayash L, Deol A, Lum L, Forman S, Ratanatharathorn V, Uberti J. Anti-thymocyte globulin (thymoglobulin), tacrolimus, and sirolimus as acute graft-versus-host disease prophylaxis for unrelated hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2012; 18:1734-44. [PMID: 22710143 DOI: 10.1016/j.bbmt.2012.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 06/06/2012] [Indexed: 10/28/2022]
Abstract
Acute graft-versus-host disease (aGVHD) is a major cause of morbidity and mortality in patients undergoing unrelated hematopoietic stem cell transplantation. We prospectively evaluated the efficacy of intermediate-dose rabbit anti-thymocyte globulin (Thymoglobulin® a total of 4.5 mg/kg given over days -3, -2, and -1) in combination with tacrolimus and sirolimus for the prevention of aGVHD. We enrolled 47 recipients who underwent unrelated hematopoietic stem cell transplantation. Patients received daily granulocyte colony-stimulating factor starting on day +6 until neutrophil engraftment (median duration, 11 days; range, 9-15 days). Twenty-two patients received HLA 8/8 and 25 received 7/8 matched grafts, respectively. The median follow-up duration was 23.6 months (range, 18.8-27.9 months). The cumulative incidence of grade II to IV aGVHD was 23.4% (95% confidence interval, 12.4-36.3). At 2-year follow-up, the cumulative incidence of nonrelapse mortality was 31.9%, cumulative incidence of relapse was 24.6%, and cumulative incidence of chronic GVHD was 33%. Progression-free survival at 1 year was 54%, with a median of 17.7 months. Overall survival at 1 year was 65%, with no median reached. These results suggest that the combination of Thymoglobulin, tacrolimus, and sirolimus in patients undergoing unrelated hematopoietic stem cell transplantation is well tolerated and associated with a low incidence and severity of aGVHD and chronic graft-versus-host disease.
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Affiliation(s)
- Zaid Al-Kadhimi
- Blood and Marrow Program, Department of Oncology, Wayne State University/Karmanos Cancer Center, Detroit, Michigan 48201, USA.
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Abidi MH, Gul Z, Abrams J, Ayash L, Deol A, Ventimiglia M, Lum L, Mellon-Reppen S, Al-Kadhimi Z, Ratanatharathorn V, Zonder J, Uberti J. Phase I trial of bortezomib during maintenance phase after high dose melphalan and autologous stem cell transplantation in patients with multiple myeloma. J Chemother 2012; 24:167-72. [PMID: 22759762 PMCID: PMC3815645 DOI: 10.1179/1973947812y.0000000004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We enrolled 15 patients in this phase I dose de-escalation trial. Twelve patients are evaluable. The primary objective was to determine the safest and best tolerated maintenance dosing (MD) of bortezomib (B). The secondary endpoints were to evaluate complete response (CR), overall response (OR) and response duration. All patients receiving autologous stem cell transplant (ASCT) were eligible and registered between D+30 to D+120 after ASCT. A maximum number of 8 cycles of B was planned. Two evaluable patients in level (L) 1 received therapeutic dose of B 1.3 mg/m(2) intravenously on days (D) 1, 4, 8, and 11 in a 21 day cycle. Both these patients experienced dose limiting toxicities (DLTs). Four evaluable patients were then enrolled in dose L2 utilizing B 1.3 mg/m(2) on D 1, 4, 8, and 11 in a 28 day cycle. Two patients in L2 developed DLTs. Six evaluable patients were thereafter enrolled in L3 utilizing B 1 mg/m(2) on D 1, 8, and 15 in a 28 day cycle. Median 8 cycles of B were administered (2-8). No DLTs were observed in L3. The median duration of follow up for the entire cohort is 33 months (12-62). The median duration of response in L3 is 29.1 months (12-33). We conclude that B 1 mg/m(2) administered intravenously and may be subcutaneously on D 1, 8, and 15 in a 28 day cycle is the best tolerated MD and can be safely given beginning around D+100 post-ASCT.
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Affiliation(s)
- Muneer H Abidi
- Department of Bone Marrow Transplantation, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA.
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Al-Kadhimi Z, Gul Z, Rodriguez R, Chen W, Mitchell A, Abidi M, Ayash L, Deol A, Lum L, Ratanatharathorn V, Uberti J. Phase II Trial: The Combination of Tacrolimus, Sirolimus, and Rabbit Anti-Thymocyte Globulin (Thymoglobulin® Thymo) to Prevent Acute Graft-vs.-Host Disease (aGVHD) in Patients Receiving Unrelated Hematopoietic Stem Cell Transplantation (UHSCT). Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gul Z, Ditah I, Abdul-Hussein M, Deol A, Ayash L, Abidi M, Lum L, Uberti J, Rratanatharathorn V, Al-Kadhimi Z. Early Lymphocyte Recovery Post Unrelated Hematopoietic Stem Cell Transplant (UHSCT) Is Associated With Better Survival and Less Acute Graft Versus Host Disease (aGVHD). Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Galili N, Ahmed A, Quddus F, Jandani S, Gul Z, Siddiki A, Mumtaz M, Mehdi M, Devuni D, Raza A. Prognostic value of low platelets in MDS patients with del(5q). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7078 The most common (10–15%) chromosomal abnormality found in myelodysplastic syndromes (MDS) is an interstitial deletion of the long arm of chromosome 5 (del(5q)). The recent finding that lenalidomide is efficacious for MDS patients with del(5q) as either the sole abnormality or as part of a complex karyotype has focused renewed interest in the prognostic characteristics of these patients. We analyzed 189 patients with del(5q), 70 having isolated and 119 having additional chromosomal abnormalities. The median survival for the isolated del(5q) patient was 2.45 years and for those with complex abnormalities was 0.63 years (p=0.001). Each of these groups was then divided by IPSS category; median survival for Low/Int1 (n=56) was 2.46 years and 0.49 years for Int2/High (n=10, p=0.019).Thus our median survival times match previously published results and we have a representative dataset. Since 5q- syndrome patients with normal to high platelets have the best survival, platelet count may be of prognostic significance. We determined the median platelet count for our dataset to be 115,000 and analyzed median survival for patients with greater (n=89) or less (n=88) than the median value. Survival for those with higher platelet counts was 2.6 years, but dropped to 0.54 years with lower counts (p=0.0001). We then analyzed each of these two groups independently for survival based on IPSS, blast % and karyotype. Median survival for patients with >115,000 platelets and either Low/Int1-risk (n=62), <5% blasts (n=46) or an isolated del(5q) (n=46) was 2.95–3.0 years. The survival of these patients dramatically decreased (0.63 years) if they had Int2/High IPSS (n=19) or >10% blasts (=11). The presence of additional chromosomal abnormalities decreased survival to 1.85 years (n=28). A different range of survival times occurred with patients that had <115,000 platelets. Their median survival based on Low/Int1 IPSS (n=20), <5% blasts (n=18) or isolated del(5q)(n=20) was only 0.68–0.84 years. Int2/High IPSS (n=64), >5% blasts (n=50) or additional chromosomal abnormalities (n=68) lowered survival to 0.44–0.49 years. Thus lower platelet counts in del(5q) MDS patients with favorable IPSS (median survival 0.84 years), <5% blasts (median survival 0.68 years) or isolated del(5q) (median survival 0.74 years) appear to have poor prognosis. No significant financial relationships to disclose.
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Affiliation(s)
- N. Galili
- Radhey Khanna MDS Center, Univ. of Massachusetts, Worcester, MA
| | - A. Ahmed
- Radhey Khanna MDS Center, Univ. of Massachusetts, Worcester, MA
| | - F. Quddus
- Radhey Khanna MDS Center, Univ. of Massachusetts, Worcester, MA
| | - S. Jandani
- Radhey Khanna MDS Center, Univ. of Massachusetts, Worcester, MA
| | - Z. Gul
- Radhey Khanna MDS Center, Univ. of Massachusetts, Worcester, MA
| | - A. Siddiki
- Radhey Khanna MDS Center, Univ. of Massachusetts, Worcester, MA
| | - M. Mumtaz
- Radhey Khanna MDS Center, Univ. of Massachusetts, Worcester, MA
| | - M. Mehdi
- Radhey Khanna MDS Center, Univ. of Massachusetts, Worcester, MA
| | - D. Devuni
- Radhey Khanna MDS Center, Univ. of Massachusetts, Worcester, MA
| | - A. Raza
- Radhey Khanna MDS Center, Univ. of Massachusetts, Worcester, MA
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Qazilbash M, Gul Z, Jindani S, Saliba R, Hosing C, Mendoza F, Qureshi S, Weber D, Wang M, Flosser T, Couriel D, De Lima M, Kebriaei P, Popat U, Alousi A, Champlin R, Giralt S. 20: Autologous stem cell transplantation for elderly patients with multiple myeloma. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.023] [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: 10/23/2022]
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Qazilbash M, Jindani S, Gul Z, Saliba R, Hosing C, Mendoza F, Qureshi S, Weber D, Wang M, Flosser T, Couriel D, Kebriaei P, Popat U, Alousi A, De Lima M, Champlin R, Giralt S. 19: Arsenic trioxide with ascorbic acid and high-dose melphalan for autologous hematopoietic stem cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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