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Yamshon S, Gribbin C, Alhomoud M, Chokr N, Chen Z, Demetres M, Pasciolla M, Leonard J, Shore T, Martin P. Safety and Toxicity Profiles of CAR T Cell Therapy in Non-Hodgkin Lymphoma: A Systematic Review and Meta-Analysis. Clin Lymphoma Myeloma Leuk 2024:S2152-2650(24)00066-1. [PMID: 38582666 DOI: 10.1016/j.clml.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The application of CD19-directed chimeric antigen receptor T (CAR T) cell therapy has improved outcomes for thousands of patients with non-Hodgkin B cell lymphoma (NHL). The toxicities associated with various CAR T cell products, however, can be severe and difficult to anticipate. METHODS In this systematic review and meta-analysis, we set out to determine whether there are measurable differences in common toxicities, including cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), cytopenias, and infections, between CAR T products that are commercially available for the treatment of NHL. RESULTS After a stringent study selection process, we used a cohort of 1364 patients enrolled in 15 prospective clinical trials investigating the use of axicabtagene ciloleucel (axi-cel), lisocabtagene maraleucel (liso-cel), and tisagenlecleucel (tisa-cel). We found that the rates of CRS and ICANS were significantly higher with axi-cel as compared to both liso-cel and tisa-cel. Conversely, we demonstrated that rates of all-grade and severe neutropenia were significantly greater with liso-cel. Febrile neutropenia and all-grade infection rates did not differ significantly between products though rates of severe infection were increased with axi-cel. CONCLUSIONS Overall, this study serves as the first to delineate toxicity profiles associated with various available CAR T products. By better understanding associated toxicities, it may become possible to tailor therapies towards individual patients and anticipate the development of toxicities at earlier stages.
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Affiliation(s)
- Samuel Yamshon
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY.
| | - Caitlin Gribbin
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Mohammad Alhomoud
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Nora Chokr
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Zhengming Chen
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Michelle Pasciolla
- Department of Pharmacy, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - John Leonard
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Tsiporah Shore
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Peter Martin
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
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Yamshon S, Gribbin C, Chen Z, Demetres M, Pasciolla M, Alhomoud M, Martin P, Shore T. Efficacy and Toxicity of CD19 Chimeric Antigen Receptor T Cell Therapy for Lymphoma in Solid Organ Transplant Recipients: A Systematic Review and Meta-Analysis. Transplant Cell Ther 2024; 30:73.e1-73.e12. [PMID: 37279856 DOI: 10.1016/j.jtct.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023]
Abstract
The safety and efficacy of chimeric antigen receptor (CAR) T cell therapy in solid organ transplant recipients is poorly understood, given the paucity of available data in this patient population. There is a theoretical risk of compromising transplanted organ function with CAR T cell therapy; conversely, organ transplantation-related immunosuppression can alter the function of CAR T cells. Given the prevalence of post-transplantation lymphoproliferative disease, which often can be difficult to treat with conventional chemoimmunotherapy, understanding the risks and benefits of delivering lymphoma-directed CAR T cell therapy in solid organ transplant recipients is of utmost importance. We sought to determine the efficacy of CAR T cell therapy in solid organ transplant recipients as well as the associated adverse effects, including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and compromised solid organ transplant function. We conducted a systematic review and meta-analysis of adult recipients of solid organ transplant who received CAR T cell therapy for non-Hodgkin lymphoma. Primary outcomes included efficacy, defined as overall response (OR), complete response (CR), progression-free survival, and overall survival, as well as rates of CRS and ICANS. Secondary outcomes included rates of transplanted organ loss, compromised organ function, and alterations to immunosuppressant regimens. After a systematic literature review and 2-reviewer screening process, we identified 10 studies suitable for descriptive analysis and 4 studies suitable for meta-analysis. Among all patients, 69% (24 of 35) achieved a response to CAR T cell therapy, and 52% (18 of 35) achieved a CR. CRS of any grade occurred in 83% (29 of 35), and CRS grade ≥3 occurred in 9% (3 of 35). Sixty percent of the patients (21 of 35) developed ICANS, and 34% (12 of 35) developed ICANS grade ≥3. The incidence of any grade 5 toxicity among all patients was 11% (4 of 35). Fourteen percent of the patients (5 of 35) experienced loss of the transplanted organ. Immunosuppressant therapy was held in 22 patients but eventually restarted in 68% of them (15 of 22). Among the studies included in the meta-analysis, the pooled OR rate was 70% (95% confidence interval [CI], 29.2% to 100%; I2 = 71%) and the pooled CR rate was 46% (95% CI, 25.4% to 67.8%; I2 = 29%). The rates of any grade CRS and grade ≥3 CRS were 88% (95% CI, 69% to 99%; I2 = 0%) and 5% (95% CI, 0% to 21%; I2 = 0%), respectively. The rates of any grade ICANS and ICANS grade ≥3 were 54% (95% CI, 9% to 96%; I2 = 68%) and 40% (95% CI, 3% to 85%; I2 = 63%), respectively. The efficacy of CAR T cell therapy in solid organ transplant recipients is comparable to that in the general population as reported in prior investigational studies, with an acceptable toxicity profile in terms of CRS, ICANS, and transplanted organ compromise. Further studies are needed to determine long-term effects on organ function, sustained response rates, and best practices peri-CAR T infusion period in this patient population.
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Affiliation(s)
- Samuel Yamshon
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York.
| | - Caitlin Gribbin
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
| | - Zhengming Chen
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York
| | - Michelle Demetres
- Samuel J. Wood Library & CV Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York
| | - Michelle Pasciolla
- Department of Pharmacy, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Mohammad Alhomoud
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
| | - Peter Martin
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
| | - Tsiporah Shore
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
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Gomez-Arteaga A, Orfali N, Pasciolla M, Baptiste A, Guindine I, Hsu J, Lin J, Mayer SA, Phillips AA, Shore TB, Simonson PD, DiCarlo E, Yoon S, Muthukumar T, van Besien K. Haploidentical allogeneic stem cell transplantation with post-transplant cyclophosphamide and subsequent kidney transplant for patients with severe sickle cell disease with end-stage kidney disease (ESKD). Bone Marrow Transplant 2023; 58:835-838. [PMID: 37045941 DOI: 10.1038/s41409-023-01981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Alexandra Gomez-Arteaga
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA.
| | - Nina Orfali
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Haematology, St James Hospital, Dublin, Ireland
| | - Michelle Pasciolla
- Department of Pharmacy, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ayanna Baptiste
- Division of Hematology and Oncology, NewYork-Presbyterian Hospital Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Inna Guindine
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jingmei Hsu
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jonathan Lin
- Division of Nephrology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
- The Rogosin Institute, New York, NY, USA
| | - Sebastian A Mayer
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Adrienne A Phillips
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tsiporah B Shore
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Paul D Simonson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Edward DiCarlo
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Sung Yoon
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Thangamani Muthukumar
- Division of Nephrology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
- The Rogosin Institute, New York, NY, USA
| | - Koen van Besien
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
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Patel C, Pasciolla M, Abramova R, Salerno D, Gomez-Arteaga A, Shore TB, Orfali N, Mayer S, Hsu J, Phillips AA, Chaekal OK, Satlin MJ, Soave R, Kodiyanplakkal RPL, Drelick A, Plate M, Besien KV. Pre-Hematopoietic Stem Cell Transplantation Rituximab for Epstein-Barr Virus and Post-Lymphoproliferative Disorder Prophylaxis in Alemtuzumab Recipients. Transplant Cell Ther 2023; 29:132.e1-132.e5. [PMID: 36334653 DOI: 10.1016/j.jtct.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
Epstein-Barr virus (EBV) reactivation and EBV-related post-transplantation lymphoproliferative disorder (PTLD) are often fatal complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The risk of EBV reactivation may be mitigated by depletion of B cells with rituximab. Starting in January 2020, allo-HSCT recipients undergoing T-cell depletion with alemtuzumab received 1 dose of rituximab before transplantation. The objective of this study was to evaluate the cumulative incidence of EBV reactivation and EBV-PTLD in recipients of allo-HSCT and in vivo T-cell depletion with alemtuzumab who received pre-HSCT rituximab compared to patients who did not. This was a single-center retrospective analysis of adult patients who consecutively received an HLA-identical allo-HSCT between January 2019 and May 2021 and in vivo T-cell depletion with alemtuzumab. Patients were included in the rituximab cohort if they received rituximab within 6 months before their transplantation. The primary endpoint was incidence of EBV reactivation at day 180 among those receiving pre-HSCT rituximab versus those not receiving rituximab. Secondary endpoints included cumulative incidence of EBV-PTLD at 1 year, time to engraftment, immune reconstitution, and incidence of infections and acute graft-versus-host disease (aGVHD) at day 180. Eighty-six consecutive patients who received an allo-HSCT with alemtuzumab T-cell depletion were reviewed; 43 patients who received pre-HSCT rituximab after our protocol modification were compared to 43 patients who did not receive pre-HSCT rituximab before this change. Median age was 57 (interquartile range [IQR] 40-69) years, and the majority of patients had acute myeloid leukemia or myelodysplastic syndrome. Baseline characteristics were similar between the cohorts. EBV reactivation at day 180 occurred in 23 (53%) patients without prior rituximab exposure versus 0 patients with pre-HSCT rituximab exposure (P < .0001). Similarly, 6 patients without prior rituximab exposure developed PTLD at 1 year compared to no cases of PTLD among patients receiving pre-HSCT rituximab. There was no difference in neutrophil engraftment, incidence of infections, or aGVHD at day 180 between the 2 cohorts. There was a delay in time to platelet engraftment in the rituximab cohort (median 16 [IQR 15-20] days versus 15 [IQR 14-17] days; P = .04). Administration of pre-HSCT rituximab before allo-HSCT in patients receiving T-cell depletion with alemtuzumab was associated with a significant decrease in the risk for EBV reactivation and EBV-PTLD, without increasing aGVHD or infection rates.
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Affiliation(s)
- Chandni Patel
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, Department of Pharmacy, New York, New York
| | - Michelle Pasciolla
- New York-Presbyterian Hospital/Weill Cornell Medical Center, Department of Pharmacy, New York, New York
| | - Rachel Abramova
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, Department of Pharmacy, New York, New York
| | - David Salerno
- New York-Presbyterian Hospital/Weill Cornell Medical Center, Department of Pharmacy, New York, New York
| | - Alexandra Gomez-Arteaga
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Tsiporah B Shore
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Nina Orfali
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Sebastian Mayer
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Jingmei Hsu
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Adrienne A Phillips
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Ok-Kyong Chaekal
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
| | - Michael J Satlin
- Weill Cornell Medical Center, Department of Medicine, Division of Infectious Diseases, New York, New York
| | - Rosemary Soave
- Weill Cornell Medical Center, Department of Medicine, Division of Infectious Diseases, New York, New York
| | | | - Alexander Drelick
- Weill Cornell Medical Center, Department of Medicine, Division of Infectious Diseases, New York, New York
| | - Markus Plate
- Weill Cornell Medical Center, Department of Medicine, Division of Infectious Diseases, New York, New York
| | - Koen Van Besien
- Weill Cornell Medical Center, Department of Medicine, Division of Hematology and Medical Oncology, New York, New York
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Orfali N, Jhanwar Y, Koo C, Pasciolla M, Baldo M, Cuvilly E, Furman R, Gergis U, Greenberg J, Guarneri D, Hsu JM, Leonard JP, Mark T, Mayer S, Maignan K, Martin P, Opong A, Pearse R, Phillips A, Rossi A, Ruan J, Rutherford SC, Ryan J, Suhu G, Van Besien K, Shore T. Sequential intensive chemotherapy followed by autologous or allogeneic transplantation for refractory lymphoma. Leuk Lymphoma 2021; 62:1629-1638. [PMID: 33586581 DOI: 10.1080/10428194.2021.1881516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We evaluate the safety of bendamustine as a bridge to stem cell transplantation (SCT) in patients with relapsed/refractory lymphoma and residual disease after salvage therapy. Thirty-four subjects without complete responses (CR) received bendamustine 200 mg/m2/day for 2 days followed 14 days later by SCT. Sixteen subjects in partial remission (PR) with maximal FDG-PET SUVs ≤8 prior to bendamustine received autologous SCT, while 13 with suboptimal responses were allografted. Five subjects did not proceed to transplant. No bendamustine toxicities precluded transplantation and no detrimental effect on engraftment or early treatment-related mortality (TRM) was attributable to bendamustine. At 1 year, 75% of auto-recipients and 31% of allo-recipients were alive with CR. Two subjects in the autologous arm developed therapy-related myeloid neoplasia (t-MN). In conclusion, a bendamustine bridge to SCT can be administered without early toxicity to patients with suboptimal responses to salvage chemotherapy. However this approach may increase the risk of t-MN. (NCT02059239).Supplemental data for this article is available online at here.
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Affiliation(s)
- Nina Orfali
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Yuliya Jhanwar
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Calvin Koo
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Michelle Pasciolla
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Maria Baldo
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Edwidge Cuvilly
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Richard Furman
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Usama Gergis
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - June Greenberg
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Danielle Guarneri
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Jing-Mei Hsu
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - John P Leonard
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Tomer Mark
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Sebastian Mayer
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Kathleen Maignan
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Peter Martin
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Adomah Opong
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Roger Pearse
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Adrienne Phillips
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Adriana Rossi
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Jia Ruan
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Sarah C Rutherford
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Jessy Ryan
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Grace Suhu
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Koen Van Besien
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
| | - Tsiporah Shore
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, USA
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Brown M, Abasov R, Salerno D, Shore TB, Gergis U, Mayer S, Phillips A, Hsu J, Kodiyanplakkal RPL, Pasciolla M, van Besien K. Impact of alemtuzumab dosing and low-dose total body irradiation on cytomegalovirus infection in allogeneic hematopoietic stem cell transplantation. Leuk Lymphoma 2020; 61:3024-3026. [PMID: 32654572 DOI: 10.1080/10428194.2020.1791855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Maxwell Brown
- Department of Pharmacy, NewYork-Presbyterian/Weill Cornell Medical Center
| | - Rza Abasov
- Department of Pharmacy, NewYork-Presbyterian/Weill Cornell Medical Center
| | - David Salerno
- Department of Pharmacy, NewYork-Presbyterian/Weill Cornell Medical Center
| | - Tsiporah B Shore
- Division of Hematology and Oncology, Department of Medicine, NewYork-Presbyterian, Weill Cornell Medical Center
| | - Usama Gergis
- Division of Hematology and Oncology, Department of Medicine, NewYork-Presbyterian, Weill Cornell Medical Center
| | - Sebastian Mayer
- Division of Hematology and Oncology, Department of Medicine, NewYork-Presbyterian, Weill Cornell Medical Center
| | - Adrienne Phillips
- Division of Hematology and Oncology, Department of Medicine, NewYork-Presbyterian, Weill Cornell Medical Center
| | - Jingmei Hsu
- Division of Hematology and Oncology, Department of Medicine, NewYork-Presbyterian, Weill Cornell Medical Center
| | | | - Michelle Pasciolla
- Department of Pharmacy, NewYork-Presbyterian/Weill Cornell Medical Center
| | - Koen van Besien
- Division of Hematology and Oncology, Department of Medicine, NewYork-Presbyterian, Weill Cornell Medical Center
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Pasciolla M, Kubin CJ, Nelson B. Use of Posaconazole Intravenous Solution and Delayed-Release Oral Tablets at a Tertiary Medical Center. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1329] [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: 11/14/2022] Open
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