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Qualls DA, Lambert N, Caimi PF, Merrill M, Pullarkat P, Godby RC, Bond DA, Wehmeyer GT, Romancik J, Amoozgar B, Leslie L, Nastoupil LJ, Crombie JL, Abramson JS, Khurana A, Nowakowski GS, Maddocks K, Rutherford SC, Kahl B, Okwali M, Buege MJ, Seshan V, Batlevi CL, Salles G. Tafasitamab and lenalidomide in large B-cell lymphoma: real-world outcomes in a multicenter retrospective study. Blood 2023; 142:2327-2331. [PMID: 37738563 PMCID: PMC10797539 DOI: 10.1182/blood.2023021274] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 09/24/2023] Open
Abstract
ABSTRACT In this real-world evaluation of tafasitamab-lenalidomide (TL) in relapsed or refractory LBCL, patients receiving TL had higher rates of comorbidities and high-risk disease characteristics, and substantially lower progression-free survival and overall survival, compared with the L-MIND registration clinical trial for TL.
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Affiliation(s)
- David A. Qualls
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Paolo F. Caimi
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mwanasha Merrill
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Priyanka Pullarkat
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, MA
| | - Richard C. Godby
- Hematology Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - David A. Bond
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Graham T. Wehmeyer
- Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Jason Romancik
- Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, GA
| | - Behzad Amoozgar
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Lori Leslie
- Lymphoma Division, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Loretta J. Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jeremy S. Abramson
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, MA
| | - Arushi Khurana
- Hematology Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Kami Maddocks
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Sarah C. Rutherford
- Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Brad Kahl
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Michelle Okwali
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael J. Buege
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Venkatraman Seshan
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connie L. Batlevi
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gilles Salles
- Lymphoma Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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Villa D, Jiang A, Visco C, Crosbie N, McCulloch R, Buege MJ, Kumar A, Bond DA, Paludo J, Maurer MJ, Thanarajasingam G, Lewis KL, Cheah CY, Baech J, El-Galaly TC, Kugathasan L, Scott DW, Gerrie AS, Lewis D. Time to progression of disease and outcomes with second-line BTK inhibitors in relapsed/refractory mantle cell lymphoma. Blood Adv 2023; 7:4576-4585. [PMID: 37307169 PMCID: PMC10425680 DOI: 10.1182/bloodadvances.2023009804] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
Time to progression of disease (POD) after first-line (1L) therapy is prognostic in mantle cell lymphoma (MCL), although studies have included a broad range of 1L, second-line (2L), and subsequent lines of therapy. The purpose of this study was to evaluate the factors predicting outcomes in patients with relapsed/refractory (R/R) MCL exclusively initiating 2L Bruton's tyrosine kinase inhibitors (BTKis) after 1L rituximab-containing therapy. Patients were accrued from 8 international centers (7 main, 1 validation cohort). Multivariable models evaluating the association between time to POD and clinical/pathologic factors were constructed and converted into nomograms and prognostic indexes predicting outcomes in this population. A total of 360 patients were included, including 160 in the main cohort and 200 in the validation cohort. Time to POD, Ki67 ≥ 30%, and MCL International Prognostic Index (MIPI) were associated with progression-free survival (PFS2) and overall survival (OS2) from the start of 2L BTKis. C-indexes were consistently ≥0.68 in both cohorts. Web/application-based calculators based on nomograms and prognostic indexes to estimate PFS2 and OS2 were constructed. The 2L BTKi MIPI identifies 3 groups with distinct 2-year PFS2, including high risk (14%), intermediate risk (50%), and low risk (64%). Time to POD, Ki67, and MIPI are associated with survival outcomes in patients with R/R MCL receiving 2L BTKis. Simple clinical models incorporating these variables may assist in planning for alternative therapies such as chimeric antigen receptor T-cell therapy, allogeneic stem cell transplantation, or novel agents with alternative mechanisms of action.
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Affiliation(s)
- Diego Villa
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Aixiang Jiang
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Nicola Crosbie
- Haematology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Rory McCulloch
- Department of Haematology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Michael J. Buege
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
- University of Illinois Chicago College of Pharmacy, Chicago, IL
| | - Anita Kumar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David A. Bond
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Matthew J. Maurer
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Katharine L. Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Chan Y. Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Joachim Baech
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Haematology, Aalborg, Denmark
| | - Tarec C. El-Galaly
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Haematology, Aalborg, Denmark
| | | | - David W. Scott
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Alina S. Gerrie
- British Columbia Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada
| | - David Lewis
- Haematology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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Buege MJ, Drill E, Horwitz SM, LeVoir A, Pak T, Peterson TJ, Dao PH, Matasar MJ. Low incidence of cardiotoxicity in patients with non-Hodgkin lymphoma receiving EPOCH after prior anthracycline exposure. Eur J Haematol 2023; 111:96-102. [PMID: 36971022 PMCID: PMC10634315 DOI: 10.1111/ejh.13971] [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: 09/19/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To describe the incidence of cardiotoxicity in patients with anthracycline exposure who subsequently receive EPOCH for non-Hodgkin lymphoma (NHL). METHODS We conducted a retrospective cohort study of adults with anthracycline exposure who subsequently received EPOCH for NHL at Memorial Sloan Kettering Cancer Center. The primary outcome was cumulative incidence of arrhythmia, heart failure (HF), left ventricular (LV) dysfunction, or cardiac death. RESULTS Among 140 patients, most had diffuse large B-cell lymphoma. Inclusive of EPOCH, median cumulative doxorubicin-equivalent dose was 364 mg/m2 ; exposure was 400 mg/m2 or higher in 41%. With median 36-month follow-up, 23 cardiac events were noted in 20 patients. Cumulative incidence of cardiac events at 60 months was 15% (95% confidence interval [CI]: 9%-21%). When limited to LV dysfunction/HF, cumulative incidence at 60 months was 7% (95% CI: 3%-13%), with most events occurring after the first year. Univariate analysis indicated only history of cardiac disease and dyslipidemia to be associated with cardiotoxicity; no other risk factors, including cumulative anthracycline dose, were identified. CONCLUSIONS In this retrospective cohort, representing the largest experience in this setting with extended follow-up, cumulative incidence of cardiac events was low. Rates of LV dysfunction or HF were particularly low, suggesting infusional administration may mitigate risk despite prior exposure.
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Affiliation(s)
- Michael J. Buege
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Esther Drill
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Steven M. Horwitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Andréa LeVoir
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Terry Pak
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Tim J. Peterson
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Phuong H. Dao
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Matthew J. Matasar
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
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4
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Buege MJ, Dao PH, Drill E, LeVoir A, Pak T, Peterson TJ, Straus DJ. IVAC With or Without Rituximab for Relapsed or Refractory B-Cell Non-Hodgkin Lymphomas: Real-World Experience in the Modern Era. Clin Lymphoma Myeloma Leuk 2021; 21:873-878. [PMID: 34413005 PMCID: PMC8643303 DOI: 10.1016/j.clml.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Part B of the modified Magrath regimen (IVAC) +/- rituximab (R) is recommended as standalone therapy by national guidelines for management of relapsed/refractory Burkitt lymphoma, and is used in other non-Hodgkin lymphomas (NHL). Activity of IVAC in B-cell NHL, particularly with R, and its toxicity remain incompletely described. PATIENTS AND METHODS We reviewed patients with relapsed/refractory B-cell NHL treated with IVAC +/- R between 2004 and 2019 at Memorial Sloan Kettering Cancer Center to assess efficacy and toxicity. RESULTS Among 54 eligible patients (median 2 prior lines of therapy), 76% had diffuse large B-cell lymphoma; 30% had central nervous system involvement at IVAC initiation. Objective response rate was 48%. At median 22-month follow-up, median progression-free and overall survival were 3.1 months and 4.9 months, respectively. Grade ≥ 3 anemia (93%), neutropenia (94%), and thrombocytopenia (100%; all grade 4) were common. Febrile neutropenia occurred in 65% and did not appear to be influenced by use of antimicrobial or granulocyte colony stimulating factor prophylaxis. Mortality was attributed to treatment in 19% of evaluable patients. CONCLUSION The clinical efficacy and utility of IVAC +/- R remain unclear. However, its profound hematologic toxicity and life-threatening complications despite prophylactic measures warrant careful consideration of alternatives.
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Affiliation(s)
- Michael J Buege
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Phuong H Dao
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Esther Drill
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andréa LeVoir
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Terry Pak
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tim J Peterson
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J Straus
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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5
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Pak TK, Dixon BN, Buege MJ, Dao PH, Leary MH, Jarrett JC, Duggan TA, Caron P, Falchi L, Hamlin P, Hamilton A, Matasar MJ, Moskowitz A, Noy A, Owens CN, Von Keudell G, Younes A, Zelenetz AD, Kumar A. Successful implementation of outpatient R ± DHAX (rituximab, dexamethasone, oxaliplatin, cytarabine) for select patients with lymphoma: a single-center experience. Leuk Lymphoma 2021; 63:876-884. [PMID: 34784853 DOI: 10.1080/10428194.2021.2002318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
R ± DHAX has been traditionally administered to inpatient due to the timing of chemotherapy administration and the perceived need for close monitoring of adverse effects. To administer R ± DHAX outpatient, a multidisciplinary task force created clinical and educational guidelines which were implemented through two phases: pilot and expansion. The pilot program determined the feasibility of transitioning R ± DHAX outpatient at a single infusion site. The expansion phase led to a service-wide implementation across all outpatient sites. A total of 40 patients were included, of which 23 patients completed all cycles, outpatient, 12 transitioned inpatient to outpatient administration, and 5 transitioned outpatient to inpatient administration. The success rate of outpatient R ± DHAX administration was 90% (36 patients successfully completed outpatient administration/40 total patients). No cytarabine-related cerebellar or ophthalmic toxicity was reported. Outpatient R ± DHAX saved 192 hospital days. R ± DHAX could be successfully administered outpatient with minimal safety concerns and reduced hospital bed utilization.
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Affiliation(s)
| | | | | | | | | | | | - Tara A Duggan
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA
| | - Philip Caron
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA.,Department of Medicine Weill Cornell Medical College, New York, NY, USA
| | - Lorenzo Falchi
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA.,Department of Medicine Weill Cornell Medical College, New York, NY, USA
| | - Paul Hamlin
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA.,Department of Medicine Weill Cornell Medical College, New York, NY, USA
| | - Audrey Hamilton
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA
| | - Matthew J Matasar
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA.,Department of Medicine Weill Cornell Medical College, New York, NY, USA
| | - Alison Moskowitz
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA.,Department of Medicine Weill Cornell Medical College, New York, NY, USA
| | - Ariela Noy
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA.,Department of Medicine Weill Cornell Medical College, New York, NY, USA
| | - Colette N Owens
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA
| | - Gottfried Von Keudell
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA.,Department of Medicine Weill Cornell Medical College, New York, NY, USA
| | - Anas Younes
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA
| | - Andrew D Zelenetz
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA.,Department of Medicine Weill Cornell Medical College, New York, NY, USA
| | - Anita Kumar
- Medicine, Memorial Sloan Kettering Cancer Center New York, New York, NY, USA.,Department of Medicine Weill Cornell Medical College, New York, NY, USA
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Yerram P, Thackray J, Modelevsky LR, Land JD, Reiss SN, Spatz KH, Levoir AC, Pak TK, Dao PH, Buege MJ, Derespiris LM, Lau C, Orozco JS, Boparai M, Koranteng LA, Reichert KE, Yan SQ, Daukshus NP, Mathew S, Buie LW, Tizon RF, Freeswick S, Liu D, Harnicar S. Outpatient clinical pharmacy practice in the face of COVID-19 at a cancer center in New York City. J Oncol Pharm Pract 2021; 27:389-394. [PMID: 33459159 DOI: 10.1177/1078155220987625] [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] [Indexed: 12/30/2022]
Abstract
PURPOSE With the rapid spread of COVID-19 in New York City since early March 2020, innovative measures were needed for clinical pharmacy specialists to provide direct clinical care safely to cancer patients. Allocating the workforce was necessary to meet the surging needs of the inpatient services due to the COVID-19 outbreak, which had the potential to compromise outpatient services. We present here our approach of restructuring clinical pharmacy services and providing direct patient care in outpatient clinics during the pandemic. DATA SOURCES We conducted a retrospective review of electronic clinical documentation involving clinical pharmacy specialist patient encounters in 9 outpatient clinics from March 1, 2020 to May 31, 2020. The analysis of the clinical pharmacy specialist interventions and the impact of the interventions was descriptive. DATA SUMMARY As hospital services were modified to handle the surge due to COVID-19, select clinical pharmacy specialists were redeployed from the outpatient clinics or research blocks to COVID-19 inpatient teams. During these 3 months, clinical pharmacy specialists were involved in 2535 patient visits from 9 outpatient clinics and contributed a total of 4022 interventions, the majority of which utilized telemedicine. The interventions provided critical clinical pharmacy care during the pandemic and omitted 199 in-person visits for medical care. CONCLUSION The swift transition to telemedicine allowed the provision of direct clinical pharmacy services to patients with cancer during the COVID-19 pandemic.
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Affiliation(s)
- Prakirthi Yerram
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer Thackray
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lisa R Modelevsky
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Josiah D Land
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samantha N Reiss
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Krisoula H Spatz
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea C Levoir
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Terry K Pak
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Phuong H Dao
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Buege
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren M Derespiris
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carmen Lau
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer S Orozco
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Manpreet Boparai
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren A Koranteng
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kate E Reichert
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shirley Q Yan
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole P Daukshus
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sherry Mathew
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larry W Buie
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard F Tizon
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scott Freeswick
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dazhi Liu
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen Harnicar
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
Objectives: To discuss (1) recent and emerging data for pharmacological management of untreated and relapsed/refractory (R/R) mantle cell lymphoma (MCL) with agents approved in the United States, (2) important considerations for toxicity monitoring and management, and (3) preliminary data and ongoing studies for agents in MCL-specific clinical trials. Data Sources: PubMed/MEDLINE, EMBASE, Google Scholar, product labeling, National Comprehensive Cancer Network, American Cancer Society, and ClinicalTrials.gov were searched for studies published between January 1, 2017, and January 31, 2020, and key historical trials. Study Selection and Data Extraction: Relevant studies conducted in humans and selected supporting preclinical data were reviewed. Data Synthesis: MCL is a rare but usually aggressive non-Hodgkin lymphoma that most commonly affects the older population. Traditionally, the treatment of MCL has been determined based on transplant eligibility. Newer data suggest that more tolerable frontline therapy may produce outcomes similar to intensive historical induction regimens, possibly precluding fewer patients from autologous stem cell transplant and producing better long-term outcomes in transplant-ineligible patients. In the R/R setting, novel regimens are improving outcomes and changing the landscape of treatment. Relevance to Patient Care and Clinical Practice: This review summarizes and discusses recent and emerging data for management of newly diagnosed and R/R MCL; key supportive care considerations for agents are also discussed. Conclusions: Recent study results are changing management of MCL. Although these data have complicated the picture of regimen selection, increasingly effective and tolerable therapy and additional anticipated data point to a brighter future for patients with MCL.
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Affiliation(s)
| | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Laura A Tang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Terry Pak
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Tim J Peterson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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8
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Endres BT, Buege MJ, Marx K, Sahasrabhojane PV, Galloway-Peña J, Garey KW, Kim J, Greenberg DE, Zhan X, Shelburne SA, Shelburne SA, Aitken SL, Aitken SL. 2682. Prophylaxis-Driven Molecular Epidemiology of Pseudomonas aeruginosa Bloodstream Infections in Adults With Leukemia. Open Forum Infect Dis 2019. [PMCID: PMC6810113 DOI: 10.1093/ofid/ofz360.2359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Fluoroquinolones (FQs) are routinely used as antimicrobial prophylaxis in leukemia patients receiving chemotherapy to prevent Pseudomonas aeruginosa infections. Patients who are intolerant to FQs may receive cefpodoxime (CPD) or other agents. How FQ use affects the resistance profile and epidemiology of breakthrough P. aeruginosa infections is unknown. To determine this, we performed a whole-genome sequencing (WGS)-driven epidemiologic study of leukemia patients with P. aeruginosa bloodstream infections. Methods All adult (age > 17 years) inpatients with leukemia and a first episode of monomicrobial P. aeruginosa bloodstream infection were included. Clinical data were extracted from the electronic medical record. Isolates were sequenced using an Illumina NextSeq and phylogenomics was performed using an in-house analysis pipeline consisting of Bowtie2, SAMtools and bcftools. Results 110 patients were included and most had a diagnosis of acute myeloid leukemia (n = 66). Twenty (18%) patients received FQ prophylaxis, 56 (54%) received CPD, and the remaining 34 (31%) received other agents. 9 (8%) isolates were multidrug-resistant (MDR). MDR was more common in those receiving FQ prophylaxis (20% vs 6%, P = 0.06). 76 sequence types (STs) were represented with ST235 (n = 8) being most common followed by ST244 (n = 7). ST235 strains were genetically distinct, but closely related (>10 but < 250 SNPs) in comparison to other STs. 2 ST244 strains were genetically identical despite being isolated 4 months apart, suggesting horizontal transmission. MDR was more common among ST235 isolates compared with other STs (38% vs 6%, P = 0.02). ST235 strains were more common in patients receiving FQ vs other prophylaxis (20% vs 4%, P = 0.04). 1 ST244 isolate harbored a VIM-2 β-lactamase. In 20 FQ-resistant isolates, 80% had mutations in either parC (S87L) or gyrA (T83I) and 50% had both. FQ-resistance mutations were more common in FQ recipients (50% vs 8%, P < 0.01). Conclusion Most P. aeruginosa infections occurred in non-FQ recipients, while MDR P. aeruginosa infections were more common in FQ recipients. These data suggest that decisions on empiric treatment of patients with P. aeruginosa bacteremia must take antimicrobial prophylaxis history into account. Disclosures Samuel L. Aitken, PharmD, Melinta Therapeutoics: Grant/Research Support, Research Grant; Merck, Sharpe, and Dohme: Advisory Board; Shionogi: Advisory Board.
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Affiliation(s)
| | | | - Kayleigh Marx
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Kevin W Garey
- University of Houston College of Pharmacy, Houston, Texas
| | - Jiwoong Kim
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Xiaowei Zhan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Samuel L Aitken
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samuel L Aitken
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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9
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Buege MJ, Do B, Lee HC, Weber DM, Horowitz SB, Feng L, Qing Y, Shank BR. Corrected calcium versus ionized calcium measurements for identifying hypercalcemia in patients with multiple myeloma. Cancer Treat Res Commun 2019; 21:100159. [PMID: 31521048 PMCID: PMC7494047 DOI: 10.1016/j.ctarc.2019.100159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND Dysregulated bone turnover is an important clinical manifestation of multiple myeloma (MM), and 30% of patients present with hypercalcemia. Serum calcium levels are routinely monitored using total calcium measurements corrected for albumin. However, myeloma-related paraproteins may bind calcium, confounding these measurements. PATIENTS AND METHODS We retrospectively analyzed correlation between corrected calcium and ionized calcium in a sample of patients with MM and a control sample of patients with breast or non-small cell lung cancers (n = 200). Multiple linear regression was used to identify variables affecting corrected calcium measurements. RESULTS Correlation between corrected calcium and ionized calcium was stronger in the control group compared to the MM group (Spearman correlation coefficient 0.85 versus 0.76, respectively). Sensitivity of corrected calcium in identifying hypercalcemia defined by elevated ionized calcium was 36% in patients with MM and 76% in the control group. Multiple linear regression did not reveal variables significantly influencing corrected calcium in the MM group, although serum paraprotein trended toward significance (p = 0.09). CONCLUSION Ionized calcium may be better than corrected calcium for detecting hypercalcemia in patients with MM. Additional analyses are needed to better quantify the clinical impact of paraprotein calcium-binding.
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Affiliation(s)
- Michael J Buege
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Ave, S710, New York, NY, United States.
| | - Bryan Do
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hans C Lee
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Donna M Weber
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sandra B Horowitz
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lei Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yun Qing
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Brandon R Shank
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Buege MJ, DiPippo AJ, DiNardo CD. Evolving Treatment Strategies for Elderly Leukemia Patients with IDH Mutations. Cancers (Basel) 2018; 10:E187. [PMID: 29882807 PMCID: PMC6025071 DOI: 10.3390/cancers10060187] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 04/21/2018] [Revised: 05/23/2018] [Accepted: 06/04/2018] [Indexed: 12/17/2022] Open
Abstract
Acute myeloid leukemia (AML) is a debilitating and life-threatening condition, especially for elderly patients who account for over 50% of diagnoses. For over four decades, standard induction therapy with intensive cytotoxic chemotherapy for AML had remained unchanged. However, for most patients, standard therapy continues to have its shortcomings, especially for elderly patients who may not be able to tolerate the complications from intensive cytotoxic chemotherapy. New research into the development of targeted and alternative therapies has led to a new era in AML therapy. For the nearly 20% of diagnoses harboring a mutation in isocitrate dehydrogenase 1 or 2 (IDH1/2), potential treatment options have undergone a paradigm shift away from intensive cytotoxic chemotherapy and towards targeted therapy alone or in combination with lower intensity chemotherapy. The first FDA approved IDH2 inhibitor was enasidenib in 2017. In addition, IDH1 inhibitors are in ongoing clinical studies, and the oral BCL-2 inhibitor venetoclax shows preliminary efficacy in this subset of patients. These new tools aim to improve outcomes and change the treatment paradigm for elderly patients with IDH mutant AML. However, the challenge of how to best incorporate these agents into standard practice remains.
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Affiliation(s)
- Michael J Buege
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Adam J DiPippo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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11
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Affiliation(s)
- Michael J. Buege
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jack E. Brown
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY
- Wegmans School of Pharmacy at St. John Fisher College, Rochester, NY
| | - Samuel L. Aitken
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX
- Center for Antimicrobial Resistance and Microbial Genomics, UTHealth McGovern Medical School, Houston, TX
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