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Gerson JN, Handorf E, Villa D, Gerrie AS, Chapani P, Li S, Medeiros LJ, Wang M, Cohen JB, Churnetski M, Hill BT, Sawalha Y, Hernandez-Ilizaliturri FJ, Kothari S, Vose JM, Bast M, Fenske T, Rao Gari SN, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B, Lansigan F, Burns T, Donovan AM, Wagner-Johnston N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Ristow K, Karmali R, Kaplan JB, Caimi PF, Rajguru S, Evens A, Klein A, Umyarova E, Pulluri B, Amengual JE, Lue JK, Diefenbach C, Fisher RI, Barta SK. Outcomes of patients with blastoid and pleomorphic variant mantle cell lymphoma. Blood Adv 2023; 7:7393-7401. [PMID: 37874912 PMCID: PMC10758713 DOI: 10.1182/bloodadvances.2023010757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma; data indicate that blastoid and pleomorphic variants have a poor prognosis. We report characteristics and outcomes of patients with blastoid/pleomorphic variants of MCL. We retrospectively studied adults with newly diagnosed MCL treated from 2000 to 2015. Primary objectives were to describe progression-free survival (PFS) and overall survival (OS). Secondary objectives included characterization of patient characteristics and treatments. Of the 1029 patients with MCL studied, a total of 207 neoplasms were blastoid or pleomorphic variants. Median follow-up period was 82 months (range, 0.1-174 months); median PFS was 38 months (95% confidence interval [CI], 28-66) and OS was 68 months (95% CI, 45-96). Factors associated with PFS were receipt of consolidative autologous hematopoietic transplantation (auto-HCT; hazard ratio [HR], 0.52; 95% CI, 0.31-0.80; P < .05), MCL International Prognostic Index (MIPI) intermediate (HR, 2.3; 95% CI, 1.2-4.3; P < .02) and high (HR, 3.8; 95% CI, 2.0-7.4; P < .01) scores, and complete response to induction (HR, 0.29 (95% CI, 0.17-0.51). Receipt of auto-HCT was not associated with OS (HR, 0.69; 95% CI, 0.41-1.16; P = .16) but was associated with MIPI intermediate (HR, 5.7; 95% CI, 2.5-13.2; P < .01) and high (HR, 10.8; 95% CI, 4.7-24.9; P < .01) scores. We report outcomes in a large cohort of patients with blastoid/pleomorphic variant MCL. For eligible patients, receipt of auto-HCT after induction was associated with improved PFS but not OS. Higher MIPI score and auto-HCT ineligibility were associated with worse survival.
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Affiliation(s)
- James N. Gerson
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Handorf
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer, Vancouver, CA
| | | | - Parv Chapani
- BC Cancer Centre for Lymphoid Cancer, Vancouver, CA
| | | | | | | | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Michael Churnetski
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | | | | | | | | | | | - Martin Bast
- University of Nebraska Cancer Center, Omaha, NE
| | - Timothy Fenske
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - David Bond
- Division of Hematology, Ohio State University, Columbus, OH
| | - Veronika Bachanova
- Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | - Bhaskar Kolla
- Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | | | | | | | - Timothy Burns
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - Marcus Messmer
- Hematologic Malignancies Division, Johns Hopkins University, Baltimore, MD
| | | | | | | | | | - Daniel J. Landsburg
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Kay Ristow
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Reem Karmali
- Division of Hematology and Oncology, Northwestern University, Evanston, IL
| | - Jason B. Kaplan
- Division of Hematology and Oncology, Northwestern University, Evanston, IL
| | - Paolo F. Caimi
- Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH
| | - Saurabh Rajguru
- Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, WI
| | - Andrew Evens
- Division of Hematology/Oncology, Tufts University, Boston, MA
| | - Andreas Klein
- Division of Hematology/Oncology, Tufts University, Boston, MA
| | - Elvira Umyarova
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | - Bhargavi Pulluri
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | | | - Jennifer K. Lue
- Division of Hematology and Oncology, Columbia University, New York, NY
| | | | - Richard I. Fisher
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Stefan K. Barta
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
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Dhakal B, Abedin S, Fenske T, Chhabra S, Ledeboer N, Hari P, Hamadani M. Response to SARS-CoV-2 vaccination in patients after hematopoietic cell transplantation and CAR T-cell therapy. Blood 2021; 138:1278-1281. [PMID: 34339501 PMCID: PMC8332674 DOI: 10.1182/blood.2021012769] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Binod Dhakal
- Blood and Marrow Transplant and Cellular Therapy Program, Department of Medicine, and
| | - Sameem Abedin
- Blood and Marrow Transplant and Cellular Therapy Program, Department of Medicine, and
| | - Timothy Fenske
- Blood and Marrow Transplant and Cellular Therapy Program, Department of Medicine, and
| | - Saurabh Chhabra
- Blood and Marrow Transplant and Cellular Therapy Program, Department of Medicine, and
| | - Nathan Ledeboer
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Parameswaran Hari
- Blood and Marrow Transplant and Cellular Therapy Program, Department of Medicine, and
| | - Mehdi Hamadani
- Blood and Marrow Transplant and Cellular Therapy Program, Department of Medicine, and
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3
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Dhakal B, Thapa B, Dong H, Tarima S, Chhabra S, D'Souza A, Drobyski W, Abid M, Shah N, Fenske T, Longo W, Hari P, Hamadani M. Budesonide Prophylaxis Reduces the Risk of Engraftment Syndrome After Autologous Hematopoietic Cell Transplantation in Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2021; 21:e775-e781. [PMID: 34257042 DOI: 10.1016/j.clml.2021.06.004] [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: 02/25/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Engraftment syndrome (ES) after autologous hematopoietic cell transplantation (AHCT) in multiple myeloma (MM) encompasses a continuum of periengraftment complications characterized by noninfectious fever, rash, diarrhea, and capillary leak features. PATIENTS AND METHODS We analyzed the ES outcomes in 257 consecutive patients MM patients who underwent AHCT at our institution from 12/2017 to 11/2019 with budesonide prophylaxis (3 mg PO daily at day +5 post-AHCT till the time of discharge) (N = 109) and no prophylaxis (N = 148). RESULTS The rates of ES were significantly higher in the no prophylaxis group versus prophylaxis group [69 (46%) vs. 23 (21%); P< .001]. There was no significant difference in length of stay (LOS) [mean 15 (±3.2) vs. 16 (±2.8); P = .27] and 30-day readmission [9 (6%) vs. 8 (7%); P = .81] between the no prophylaxis and prophylaxis groups, respectively. On adjusted analysis, budesonide prophylaxis was associated with a significantly lower risk of developing ES [odds ratio (OR) 0.29 (95% confidence interval [CI], 0.16-0.51); P< .0001]. There was no difference in the 30-day readmission rates [OR 1.12 (95% CI, 0.41-3.03); P = .81], but a trend for shorter LOS in the prophylaxis group [7.3% reduction in LOS (95% CI, -14.4% to 0%); P = .06]. CONCLUSION Budesonide prophylaxis significantly reduces the risk of ES in MM patients undergoing AHCT. These promising results suggest the need for a randomized study investigate the role of budesonide for ES prophylaxis.
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Affiliation(s)
- Binod Dhakal
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI.
| | - Bicky Thapa
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI
| | - Huaying Dong
- Institute of Health and Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Sergey Tarima
- Institute of Health and Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Saurabh Chhabra
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI
| | - Anita D'Souza
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI
| | - William Drobyski
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI
| | - Muhammad Abid
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI
| | - Nirav Shah
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy Fenske
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI
| | - Walter Longo
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI
| | - Parameswaran Hari
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI
| | - Mehdi Hamadani
- Division of BMT & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI
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4
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Zurko J, Xu H, Chaney K, Fenske T, Hamadani M, Schneider D, Dropulic B, Hari P, Johnson B, Shah N. 8-day versus 12-day manufacturing of LV20.19 CAR T-cells impacts single cell cytokine profiles without increasing severity of toxicities. Cytotherapy 2021. [DOI: 10.1016/s1465324921004060] [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: 10/21/2022]
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5
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Shah NN, Ahn KW, Litovich C, Fenske T, Hamadani M. Is autologous transplantation (autoHCT) in relapsed diffuse large B-cell lymphoma (DLBCL) patients achieving only a PET/CT positive partial remission (PR) appropriate in the CAR-T cell era? J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
8000 Background: In relapsed, chemosensitive DLBCL patients (pts), autoHCT consolidation is a standard therapy option. With the approval of anti-CD19 CAR T-cells in 2017, relapsed DLBCL pts with residual PET/CT avid disease after salvage therapies are increasingly being offered CAR T-cells in lieu of autoHCT. According to Center for International Blood and Marrow Transplant Research (CIBMTR) data in 2018, the number of autoHCT for DLBCL in the U.S. decreased by ~45% from prior years, likely due to application of CAR T-cells for both chemorefractory DLBCL and chemosensitive DLBCL pts not achieving a complete remission. Using the CIBMTR database, we report outcomes of autoHCT in relapsed chemosensitive DLBCL pts achieving only a PET/CT+ PR prior to HCT. Methods: 249 relapsed DLBCL pts undergoing an autoHCT from 2003-13 with a PET/CT+ PR prior to transplant were identified. The study cohort was divided into two groups: (a) early chemo-immunotherapy failure (ECF) defined as pts with primary refractory disease (PRefD) or relapse within 12 months of diagnosis, (b) late chemoimmunotherapy failure (LCF) defined as pts relapsing ≥12 months. Primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS) and relapse. Results: 182 pts had ECF and 67 pts had LCF. The median age of ECF pts was 57 years versus (vs) 63 years for LCF (p < 0.01). ECF pts more frequently had stage III-IV at diagnosis (74% vs 54%, p = < 0.01). 79% of ECF pts had PRefD. The most common conditioning regimen was BEAM in both cohorts. The adjusted 5-year probabilities for PFS and OS (ECF vs LCF) was not different between the 2 cohorts: 41% vs 41% (p = 0.93) and 51% vs 63% (p = 0.09), respectively. Cumulative incidence of relapse at 5 years in similar order was 48% vs 57%, p = 0.27. On multivariate analysis compared to the LCF, pts with ECF had an increased risk of death (HR = 1.61, 95%CI 1.05-2.46, p = 0.03) but no increased risk in PFS or relapse. Conclusions: Using the CIBMTR registry, we report outcomes of relapsed DLBCL pts in a PR with residual PET/CT avid disease at time of autoHCT. While OS favored LCF pts, the adjusted 5-year PFS (41%) was comparable in both cohorts. This 5 year PFS is comparable to results reported in historical trials of auto-HCT for DLBCL. With no randomized data demonstrating superiority of CAR T-cell therapy in chemosensitive PR patients, these findings strongly support that autoHCT should remain the current standard of care for this patient population.
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Affiliation(s)
| | - Kwang Woo Ahn
- Division of Biostatistics, Institution for Health and Society, Medical College of Wisconsin, Milwaukee, WI
| | - Carlos Litovich
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
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6
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Karmali R, Switchenko JM, Goyal S, Bachanova V, Gerson J, Barta SK, Danilov AV, Grover NS, Epperla N, Burkart M, Sawalha Y, Ghosh N, Bond DA, Maddocks KJ, Badar T, Fenske T, Guo J, Malecek MK, Martin P, Cohen JB. Older patients with mantle cell lymphoma (MCL): Practice patterns and predictors of survival in the rituximab era. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20064] [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
e20064 Background: Therapeutic intensity poses a challenge for older or medically unfit pts with untreated MCL. We assessed clinical outcomes and predictors of survival in older MCL pts treated in the rituximab era. Methods: We included pts ≥ 65 yrs of age with newly diagnosed MCL treated between 2000 and 2015. The primary objective was to characterize practice patterns and survival outcomes in older pts and secondarily to assess predictive factors of survival. Results: Data were collected from 12 centers for 1168 pts. For 465 pts ≥ 65 yrs of age (median 70; range 65-100), variable denominators indicate missing data: 305 of 444 pts (69%) were male; 23 (8%), 110 (39%) and 148 (53%) of 281 pts had low, intermediate and high-risk MIPI respectively. Median time from diagnosis to first treatment was 31 days (range 0-2611 days). In 407 older pts with initial treatment data, 148 (36%) received BR, 65 (16%) a cytarabine containing regimen, 9 (2%) lenalidomide, and 92 (23%) other treatments that excluded BTK inhibitors (BTKi). 68 of 365 pts (19%) were enrolled on clinical trial for initial therapy, 88 of 369 pts (24%) received autologous transplant (AHCT) in first remission, and 155 of 351 pts (44%) received maintenance rituximab (MR). Median f/u was 2.7 yrs. 41 of 465 pts (9%) had primary refractory disease (POD6); 107 (23%) progressed within 24 months (POD24). Treatment data were available for 157 relapsing pts: 58 (37%) were treated with BTKi/BTKi combinations. PFS and OS rates were compared across young and older age cohorts: 2 yr PFS rates were 79%, 69%, and 66% and 2 yr OS rates were 92%, 87%, and 84% for age < 65, age 65-69, and age ≥ 70 respectively (p < 0.001). In the older cohort: on UVA, ECOG ≥2, BM involvement, blastoid histology, > 3 cytogenetic abnormalities and lack of MR were associated with inferior PFS and OS (p = 0.012 – < 0.001). POD6 and POD24 were associated with decreased OS (p < 0.001). AHCT in first remission did not impact PFS or OS. After MVA, MR remained significantly associated with improved PFS and OS (p < 0.001). 2 yr PFS rates were 81% and 58% and 2 yr OS rates were 96% and 80% with and without MR respectively (p < 0.001). Conclusions: In this large cohort of older pts in the rituximab era, survival outcomes remain inferior to younger pts. MR is associated with improved PFS and OS but AHCT does not yield better survival. A small number of pts received BTKi salvage therapy. As such, our data does not reliably reflect the potential advancements in survival achieved with the introduction of BTKis. Focused clinical trials are necessary to identify effective therapeutics in this population.
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Affiliation(s)
- Reem Karmali
- Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Subir Goyal
- Winship Cancer Institute and Rollins School of Public Health at Emory University, Atlanta, GA
| | | | | | | | | | - Natalie Sophia Grover
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | - David Alan Bond
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Kami J. Maddocks
- Department of Internal Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Jin Guo
- Weill Cornell Medical College, Manhattan, NY
| | | | - Peter Martin
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
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7
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Diefenbach C, Hong F, Ambinder R, Cohen J, Robertson M, David K, Advani R, Fenske T, Barta S, Palmisano N, Svoboda J, Morgan D, Karmali R, Kahl B, Ansell S. EXTENDED FOLLOW-UP OF A PHASE I TRIAL OF IPILIMUMAB, NIVOLUMAB AND BRENTUXIMAB VEDOTIN IN RELAPSED HODGKIN LYMPHOMA: A TRIAL OF THE ECOG-ACRIN RESEARCH GROUP (E4412). Hematol Oncol 2019. [DOI: 10.1002/hon.83_2629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- C.S. Diefenbach
- Hematology-Oncology; Perlmutter Cancer Center at NYU Langone Health; New York United States
| | - F. Hong
- ECOG-ACRIN Biostatistics Center; Dana Farber Cancer Institute; Boston United States
| | - R. Ambinder
- Sidney Kimmel Cancer Center; Johns Hopkins University; Baltimore MD United States
| | - J. Cohen
- Winship Cancer Institute; Emory University; Atlanta United States
| | - M. Robertson
- Hematology-Oncology; Indiana Unversity School of Medicine; Indianapolis United States
| | - K. David
- Hematology-Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | - R. Advani
- Oncology; Stanford Cancer Institute; San Francisco United States
| | - T. Fenske
- Hematology-Oncology; Froedtert and the Medical College of Wisconsin; Milwaukee United States
| | - S. Barta
- Abramson Cancer Center; University of Pennsylvania; Philadelphia United States
| | - N. Palmisano
- Hematology-Oncology; Thomas Jefferson University Hospital; Philadelphia United States
| | - J. Svoboda
- Abramson Cancer Center; University of Pennsylvania; Philadelphia United States
| | - D. Morgan
- Hematology-Oncology; Vanderbilt Ingram Henry Cancer Center; Nashville United States
| | - R. Karmali
- Feinberg School of Medicine; Northwestern University; Chicago United States
| | - B. Kahl
- Oncology; Washington University School of Medicine; St. Louis United States
| | - S. Ansell
- Hematology-Oncology; Mayo Clinic; Rochester United States
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8
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Jagadeesh D, Tsai D, Wei W, Wagner-Johnston N, Xie E, Berg S, Smith S, Koff J, Barot S, Hwang D, Kim S, Venugopal P, Fenske T, Sriram D, David K, Santapuram P, Reddy N, Dharnidharka V, Evens A. POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER (PTLD) AFTER SOLID ORGAN TRANSPLANT (SOT): SURVIVAL AND PROGNOSTICATION AMONG 570 PATIENTS (PTS) TREATED IN THE MODERN ERA. Hematol Oncol 2019. [DOI: 10.1002/hon.116_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- D. Jagadeesh
- Hematology and Medical Oncology; Cleveland Clinic; Cleveland United States
| | - D. Tsai
- Hematology/Oncology; University of Pennsylvania; Philadelphia United States
| | - W. Wei
- Hematology and Medical Oncology; Cleveland Clinic; Cleveland United States
| | - N. Wagner-Johnston
- Hematology and Oncology; Johns Hopkins Medical Institution; Baltimore United States
| | - E. Xie
- Hematology and Oncology; Johns Hopkins Medical Institution; Baltimore United States
| | - S. Berg
- Hematology and Oncology; Loyola University Medical Center; Melrose Park United States
| | - S.E. Smith
- Hematology and Oncology; Loyola University Medical Center; Melrose Park United States
| | - J.L. Koff
- Hematology and Medical Oncology; Emory University; Atlanta United States
| | - S. Barot
- Hematology and Medical Oncology; Cleveland Clinic; Cleveland United States
| | - D. Hwang
- Hematology and Oncology; Loyola University Medical Center; Melrose Park United States
| | - S. Kim
- Hematology and Oncology; Rush University Medical Center; Chicago United States
| | - P. Venugopal
- Hematology and Oncology; Rush University Medical Center; Chicago United States
| | - T. Fenske
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - D. Sriram
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - K. David
- Hematology and Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | - P. Santapuram
- Department of Medicine; Vanderbilt University Medical Center; Nashville United States
| | - N. Reddy
- Department of Medicine; Vanderbilt University Medical Center; Nashville United States
| | - V. Dharnidharka
- Pediatric Nephrology; Hypertension and Pheresis, Washington University School of Medicine & St. Louis Children's Hospital; St. Louis United States
| | - A.M. Evens
- Hematology and Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
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9
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Bond D, Switchenko J, Maddocks K, Churnetski M, Goyal S, Shanmugasundaram K, Calzada O, Kolla B, Bachanova V, Gerson J, Barta S, Hill B, Salwaha Y, Martin P, Maldonado E, Gordon M, Danilov A, Grover N, Mathews S, Burkart M, Karmali R, Ghosh N, Park S, Epperla N, Badar T, Guo J, Hamadani M, Fenske T, Malecek M, Kahl B, Flowers C, Blum K, Cohen J. OUTCOMES FOR PATIENTS WITH MANTLE CELL LYMPHOMA EXPERIENCING FRONTLINE TREATMENT FAILURE: A MULTICENTER RETROSPECTIVE STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.77_2631] [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: 11/12/2022]
Affiliation(s)
- D.A. Bond
- Division of Hematology; Ohio State University Comprehensive Cancer Center; Columbus United States
| | - J. Switchenko
- Department of Biostatistics and Bioinformatics; Rollins School of Public Health, Emory University; Atlanta United States
| | - K. Maddocks
- Division of Hematology; Ohio State University Comprehensive Cancer Center; Columbus United States
| | - M. Churnetski
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - S. Goyal
- Department of Biostatistics and Bioinformatics; Rollins School of Public Health, Emory University; Atlanta United States
| | - K. Shanmugasundaram
- Department of Internal Medicine; Emory University School of Medicine; Atlanta United States
| | - O. Calzada
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - B. Kolla
- Department of Hematology; University of Minnesota; Minneapolis United States
| | - V. Bachanova
- Department of Hematology; University of Minnesota; Minneapolis United States
| | - J. Gerson
- Hematology; Abramson Cancer Center, University of Pennsylvania; Pennsylvania United States
| | - S. Barta
- Hematology; Abramson Cancer Center, University of Pennsylvania; Pennsylvania United States
| | - B. Hill
- Hematology and Oncology; Cleveland Clinic Taussig Cancer Institute; Cleveland United States
| | - Y. Salwaha
- Hematology and Oncology; Cleveland Clinic Taussig Cancer Institute; Cleveland United States
| | - P. Martin
- Department of Medicine; Weil Cornell Medicine; New York United States
| | - E. Maldonado
- Hematology and Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland United States
| | - M. Gordon
- Hematology and Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland United States
| | - A. Danilov
- Hematology and Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland United States
| | - N. Grover
- Hematology and Oncology; University of North Carolina Lineberger Comprehensive Cancer Center; Chapel Hill United States
| | - S. Mathews
- Hematology and Oncology; University of North Carolina Lineberger Comprehensive Cancer Center; Chapel Hill United States
| | - M. Burkart
- Hematology and Oncology; Northwestern University, Feinberg School of Medicine; Chicago United States
| | - R. Karmali
- Hematology and Oncology; Northwestern University, Feinberg School of Medicine; Chicago United States
| | - N. Ghosh
- Hematology and Oncology; Atrium Health; Charlotte United States
| | - S. Park
- Hematology and Oncology; Atrium Health; Charlotte United States
| | - N. Epperla
- Division of Hematology; Ohio State University Comprehensive Cancer Center; Columbus United States
| | - T. Badar
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - J. Guo
- Department of Medicine; Weil Cornell Medicine; New York United States
| | - M. Hamadani
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - T. Fenske
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - M. Malecek
- Hematology and Oncology; Siteman Cancer Center, Washington University; St. Louis United States
| | - B. Kahl
- Hematology and Oncology; Siteman Cancer Center, Washington University; St. Louis United States
| | - C. Flowers
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - K. Blum
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - J. Cohen
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
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10
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Shah NN, Zhu F, Schneider D, Taylor C, Krueger W, Worden A, Longo WL, Hamadani M, Fenske T, Johnson B, Dropulic B, Orentas R, Hari P. Results of a phase I study of bispecific anti-CD19, anti-CD20 chimeric antigen receptor (CAR) modified T cells for relapsed, refractory, non-Hodgkin lymphoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2510] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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
2510 Background: Anti-CD19 CAR-T cell therapy is a breakthrough treatment (tx) for patients (pts) with relapsed/refractory (R/R) B-cell non-Hodgkin lymphoma (NHL). Despite impressive outcomes, non-response and relapse with CD19 negative disease remain challenges. Through dual B-cell antigen targeting of CD20 and CD19, with a first-in-human bispecific lentiviral CAR-T cell (LV20.19CAR), we aim to improve response rates while limiting CD19 negative relapse. Methods: Pts were treated on a Phase 1 dose escalation + expansion trial (NCT03019055) to demonstrate safety of a 41BB/CD3z LV20.19CAR T cell for adults with R/R B-cell NHL. Safety was assessed by incidence of dose limiting toxicities (DLTs) within 28 days post-infusion. Starting dose was 2.5 x 10^5 cells/kg with a target dose of 2.5 x 10^6 cells/kg. All pts received fludarabine+cyclophosphamide for lymphodepletion. Results: 11 pts have completed tx to date. 9 pts in dose escalation and 2 pts in expansion phase. Median age was 54 years (46-67) and histology included DLBCL = 5 pts, MCL = 4 pts, and CLL = 2 pts. In dose escalation, 3 pts were treated at 2.5 x 10^5 cells/kg, 3 pts at 7.5 x 10^5 cells/kg, and 3 pts at 2.5 x 10^6 cells/kg with no DLTs. As a result, 2.5 x 10^6 cells/kg was selected for expansion. In terms of safety, 6 pts developed Grade 1-2 cytokine release syndrome (CRS) and 3 pts had Grade 1-2 neurotoxicity (NTX). No patient had grade 3-4 CRS or NTX and none required ICU level care. 4 pts required 1-2 doses of tocilizumab for CRS. The day 28 overall response rate (ORR) for all pts was 82% (6/11 = complete response (CR) and 3/11 = partial response). All CR pts remain in remission, the longest > 1 year. All progressing pts underwent repeat biopsy, and all retained either CD19 or CD20 positivity. Additional pts are being enrolled in the expansion phase and updated data will be presented. Conclusions: Phase 1 results from the LV20.19 CAR T clinical trial demonstrate that infusion of 2.5 x 10^6 cells/kg is safe for further investigation with no DLTs among treated pts. Down-regulation of target antigens was not identified as a mechanism of resistance in progressing pts. With limited toxicity and encouraging ORR, dual targeted LV20.19CAR T cells merits further investigation. Clinical trial information: NCT03019055.
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Affiliation(s)
| | - Fenlu Zhu
- Medical College of Wisconsin, Milwaukee, WI
| | - Dina Schneider
- Lentigen Technology Inc., A Miltenyi Biotec Company, Gaithersburg, MD
| | | | - Winfried Krueger
- Lentigen Technology Inc., A Miltenyi Biotec Company, Gaithersburg, MD
| | - Andrew Worden
- Lentigen Technology Inc., A Miltenyi Biotec Company, Gaithersburg, MD
| | | | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Boro Dropulic
- Lentigen Technology Inc., A Miltenyi Biotec Company, Gaithersburg, MD
| | - Rimas Orentas
- Lentigen Technology Inc., A Miltenyi Biotec Company, Gaithersburg, MD
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11
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Guru Murthy GS, Hari PN, Szabo A, Pasquini M, Narra R, Khan M, Abedin S, Chhabra S, Dhakal B, D'Souza A, Drobyski WR, Rizzo JD, Runaas L, Shah NN, Shaw B, Saber W, Fenske T, Hamadani M. Outcomes of Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Performed in the Inpatient versus Outpatient Setting. Biol Blood Marrow Transplant 2018; 25:827-833. [PMID: 30572109 DOI: 10.1016/j.bbmt.2018.12.069] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) with reduced-intensity conditioning (RIC) is commonly performed as an inpatient procedure. The feasibility and outcomes of RIC allo-HCT in the outpatient setting is not known. We performed a single-center retrospective cohort study of patients aged ≥ 18years with hematologic malignancies who underwent RIC allo-HCT either in the inpatient or outpatient setting. Donor types included HLA-matched sibling and well-matched unrelated donors. The objectives were to compare the survival, complications, charges, and incidences of relapse, nonrelapse mortality (NRM), and acute and chronic graft-versus-host disease (GVHD) between the 2 groups. Between 2014 and 2017, 151 eligible patients were included, with 116 undergoing RIC allo-HCT in the inpatient setting and 35 patients undergoing RIC allo-HCT in the outpatient setting. Baseline characteristics were comparable between the 2 groups except for a higher proportion of patients with myeloma in the outpatient cohort (inpatient 15.5% versus outpatient 37.1%). The cumulative incidence of grades II to IV acute GVHD (inpatient 25.2% versus outpatient 25.7%), grades III to IV acute GVHD (inpatient 10.4% versus outpatient 8.5%), chronic GVHD (inpatient 38.3% versus outpatient 51.6%), NRM at 1 year (inpatient 10.8% versus outpatient 3.2%), and relapse (inpatient 24.8% versus outpatient 33.2%) did not significantly differ between the 2 cohorts. One-year progression-free survival (inpatient 64.4% versus outpatient 63.6%, P = .39) and overall survival (inpatient 73.8% versus outpatient 82.8%, P = .93) were also not significantly different between the 2 groups. The proportion of patients who developed neutropenic fever (inpatient 25.8% versus outpatient 8.5%, P = .03) and mucositis (inpatient 50.8% versus outpatient 8.5%, P < .001) and who required total parenteral nutrition (inpatient 20.6% versus outpatient 5.7%, P = .04) were more frequent in the inpatient cohort. About 51.5% of the outpatient cohort never required hospital admission in the first 100days. Outpatient HCT resulted in significantly lower charges than inpatient HCT in the first 100days (median charges: inpatient $339,621 versus outpatient $247,334; P < .001). On multivariate analysis the site of the HCT (outpatient versus inpatient) was not a significant predictor of either overall or progression-free survival. Outpatient RIC allo-HCT is feasible and safe with daily outpatient evaluation and aggressive supportive care resulting in outcomes comparable with those who received the transplant in the inpatient setting.
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Affiliation(s)
- Guru Subramanian Guru Murthy
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran N Hari
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo Pasquini
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ravi Narra
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Muhammad Khan
- Division of Hospital Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sameem Abedin
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Binod Dhakal
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William R Drobyski
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - J Douglas Rizzo
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lyndsey Runaas
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nirav N Shah
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen Shaw
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wael Saber
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy Fenske
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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12
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Sureda A, Zhang MJ, Dreger P, Carreras J, Fenske T, Finel H, Schouten H, Montoto S, Robinson S, Smith SM, Boumedil A, Hamadani M, Pasquini MC. Allogeneic hematopoietic stem cell transplantation for relapsed follicular lymphoma: A combined analysis on behalf of the Lymphoma Working Party of the EBMT and the Lymphoma Committee of the CIBMTR. Cancer 2018; 124:1733-1742. [PMID: 29424927 DOI: 10.1002/cncr.31264] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/01/2017] [Accepted: 12/29/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HCT) remains the only potentially curative treatment option for relapsed follicular lymphoma (FL), yet questions remain about the optimal timing. This study analyzed long-term outcomes and associated factors among recipients of allo-HCT with FL. METHODS Patients with relapsed FL who underwent allo-HCT from 2001 to 2011 with a human leukocyte antigen (HLA)-matched donor were included. Outcome analyses for overall survival (OS), progression-free survival (PFS), transplant-related mortality (TRM), and disease relapse/progression were calculated. A multivariate analysis was performed to determine factors associated with outcomes, and a prognostic score for treatment failure was developed in a subset analysis of patients. RESULTS In all, 1567 patients with relapsed FL were included; the median follow-up was 55 months. The 5-year probabilities of OS and PFS were 61% and 52%, respectively. The 5-year cumulative incidences of disease progression/relapse and TRM were 29% and 19%, respectively. Chemoresistant disease, older age, heavy pretreatment, poor performance status (PS), and myeloablative protocols were predictors for worse survival. The prognostic score, using age, lines of prior therapy, disease status, and PS, stratified patients into 3 groups-low, intermediate, and high risk-with 5-year PFS rates of 68%, 53%, and 46%, respectively, and 5-year OS rates of 80%, 62%, and 50%, respectively. CONCLUSIONS Allo-HCT should be considered for patients with relapsed FL and available HLA-matched donors. Outcomes are better in earlier phases of the disease, and reduced-intensity conditioning should be preferred. The prognostic score presented here can assist in counseling patients and determining the time to proceed to transplantation. Cancer 2018;124:1733-42. © 2018 American Cancer Society.
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Affiliation(s)
- Anna Sureda
- Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter Dreger
- Universitaetsklinkum Heidelberg, Heidelberg, Germany
| | - Jeanette Carreras
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Herve Finel
- Central Registry Office, European Society for Blood and Marrow Transplantation, Paris, France
| | - Harry Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, the Netherlands
| | - Silvia Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Ariane Boumedil
- Central Registry Office, European Society for Blood and Marrow Transplantation, Paris, France
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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13
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Thompson J, Yin Z, D'Souza A, Fenske T, Hamadani M, Hari P, Rizzo JD, Pasquini M, Saber W, Shah N, Shaw BE, Shahir K, Banerjee A, Drobyski WR. Etanercept and Corticosteroid Therapy for the Treatment of Late-Onset Idiopathic Pneumonia Syndrome. Biol Blood Marrow Transplant 2017; 23:1955-1960. [PMID: 28757436 DOI: 10.1016/j.bbmt.2017.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/21/2017] [Indexed: 12/23/2022]
Abstract
Idiopathic pneumonia syndrome (IPS) is a complication of allogeneic hematopoietic stem cell transplantation (HSCT) that typically occurs within the first 100 days after transplantation. Tumor necrosis factor α (TNF-α) has been shown to be a key mediator of IPS, and the TNF-α binding protein etanercept appeared to improve IPS outcomes in small retrospective and prospective studies. IPS also has been observed to occur later (>100 days) after HSCT; however, little is known about the disease course and whether a TNF-α-based therapeutic strategy is efficacious in these patients. To address this question, we performed a retrospective analysis of 23 patients who underwent HSCT between 2004 and 2016 at our institution who developed late-onset IPS and received treatment with etanercept and high-dose corticosteroids (CS). Ten of the 23 patients (43%) attained a complete clinical response to etanercept and CS. Responses were significantly more likely to occur in patients who did not require positive pressure ventilation at the time of diagnosis. Those who responded experienced a durable survival benefit, with a 2-year overall survival of 67%. In the 13 patients (57%) who did not respond to etanercept and CS, the median overall survival was only 13 days (range, 1 to 60 days). The difference in 2-year overall survival between responders and nonresponders was statistically significant (67% versus 0%; P < .001). These results indicate that late-onset IPS carries high mortality, but that treatment with etanercept and CS has activity and can result in long-term survival in some patients. Prompt diagnosis and early institution of therapy before the need for advanced respiratory support is critical for maximizing responses.
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Affiliation(s)
- Jonathan Thompson
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ziyan Yin
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran Hari
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - J Douglas Rizzo
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo Pasquini
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wael Saber
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nirav Shah
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen E Shaw
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kaushik Shahir
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William R Drobyski
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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14
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Burris HA, Flinn I, Lunning MA, Vose J, Fowler NH, Nastoupil LJ, O'Brien SM, Schreeder MT, Patel MR, Fenske T, Brander DM, Siddiqi T, Flowers C, Burger JA, Wierda WG, Kuhn JG, Sportelli P, Miskin HP, Weiss MS, O'Connor OA. Long-term follow-up of the PI3Kδ inhibitor TGR-1202 to demonstrate a differentiated safety profile and high response rates in CLL and NHL: Integrated-analysis of TGR-1202 monotherapy and combined with ublituximab. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Howard A. Burris
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | - Ian Flinn
- Hematologic Malignancies Research Program, Sarah Cannon Research Institute, Nashville, TN
| | | | - Julie Vose
- University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | - Manish R. Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL
| | | | | | | | | | | | | | - John G. Kuhn
- University of Texas Health Science Center San Antonio, San Antonio, TX
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15
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Laport GG, Wu J, Logan B, Bachanova V, Hosing C, Fenske T, Longo W, Devine SM, Nademanee A, Gersten I, Horowitz M, Lazarus HM, Riches ML. Reduced-Intensity Conditioning with Fludarabine, Cyclophosphamide, and High-Dose Rituximab for Allogeneic Hematopoietic Cell Transplantation for Follicular Lymphoma: A Phase Two Multicenter Trial from the Blood and Marrow Transplant Clinical Trials Network. Biol Blood Marrow Transplant 2016; 22:1440-1448. [PMID: 27118571 DOI: 10.1016/j.bbmt.2016.04.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
Allogeneic (allo) hematopoietic cell transplantation (HCT) can induce long-term remissions in chemosensitive relapsed follicular lymphoma (FL). The Blood and Marrow Transplant Clinical Trials Network conducted a multicenter phase 2 trial to examine the efficacy of alloHCT using reduced-intensity conditioning with rituximab (RTX) in multiply relapsed, chemosensitive FL. The primary endpoint was 2-year progression-free survival (PFS). The conditioning regimen consisted of fludarabine, cyclophosphamide, and high-dose RTX (FCR), in which 3 of the 4 doses of RTX were administered at a dose of 1 gm/m(2). Graft-versus-host disease (GVHD) prophylaxis was with tacrolimus and methotrexate. Sixty-five patients were enrolled and 62 were evaluable. Median age was 55 years (range, 29 to 74). This group was heavily pretreated: 77% had received ≥ 3 prior regimens, 32% had received ≥ 5 prior regimens, and 11% had received prior autologous HCT. Donors were HLA-matched siblings (n = 33) or HLA-matched unrelated adults (n = 29). No graft failures occurred. The overall response rate after HCT was 94% with 90% in complete remission (CR), including 24 patients not in CR before alloHCT. With a median follow-up of 47 months (range, 30 to 73), 3-year PFS and overall survival rates were 71% (95% confidence interval, 58% to 81%) and 82% (95% confidence interval, 70% to 90%), respectively. Three-year cumulative incidences of relapse/progression and nonrelapse mortality were 13% and 16%, respectively. Two-year cumulative incidences of grades 2 to 4 and grades 3 or 4 acute GVHD were 27% and 10%, respectively, and extensive chronic GVHD incidence was 55%. Serum RTX concentrations peaked at day +28 and remained detectable as late as 1 year in 59% of patients with available data. In conclusion, alloHCT with FCR conditioning confers high CR rates, a low incidence of relapse/progression, and excellent survival probabilities in heavily pretreated FL patients.
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Affiliation(s)
- Ginna G Laport
- Stanford University Medical Center, Stanford, California
| | - Juan Wu
- The EMMES Corporation, Rockville, Maryland
| | - Brent Logan
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Chitra Hosing
- University of Texas/MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | | | | | | | - Marcie L Riches
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina.
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16
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Aqeel M, Uysal-Biggs N, Fenske T. Coexistent Primary Lung Adenocarcinoma and Mantle Cell Lymphoma: A Case Report. Chest 2015. [DOI: 10.1378/chest.2281272] [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: 11/01/2022] Open
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17
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Landsburg DJ, Petrich AM, Abramson JS, Sohani A, Press OW, Cassaday RD, Chavez JC, Song KW, Zelenetz AD, Gandhi M, Shah NM, Fenske T, Jasso J, Medeiros LJ, Yang DT, Nabhan C. Analysis of “double-hit” lymphoma cases by genetic subtype. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8543] [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)
| | | | | | | | | | | | | | | | | | | | | | | | - Jesse Jasso
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David T Yang
- University of Wisconsin Carbone Cancer Center, Madison, WI
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18
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Kroll TM, Singavi A, Schmidt W, Eastwood D, Drobyski W, Horowitz MM, Palmer J, Pasquini MC, Rizzo JD, Saber W, Hari PN, Fenske T. Safety of Outpatient Autologous Hematopoietic Cell Transplantation (AuHCT) for Multiple Myeloma and Lymphoma. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.166] [Citation(s) in RCA: 2] [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: 11/24/2022]
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19
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Vose JM, Carter S, Burns LJ, Ayala E, Press OW, Moskowitz CH, Stadtmauer EA, Mineshi S, Ambinder R, Fenske T, Horowitz M, Fisher R, Tomblyn M. Phase III randomized study of rituximab/carmustine, etoposide, cytarabine, and melphalan (BEAM) compared with iodine-131 tositumomab/BEAM with autologous hematopoietic cell transplantation for relapsed diffuse large B-cell lymphoma: results from the BMT CTN 0401 trial. J Clin Oncol 2013; 31:1662-8. [PMID: 23478060 DOI: 10.1200/jco.2012.45.9453] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This clinical trial evaluated standard-dose radioimmunotherapy with a chemotherapy-based transplantation regimen followed by autologous hematopoietic cell transplantation versus rituximab with the same regimen in patients with relapsed diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS Patients with chemotherapy-sensitive persistent or relapsed DLBCL were randomly assigned to receive iodine-131 tositumomab (dosimetric dose of 5 mCi on day -19 and therapeutic dose of 0.75 Gy on day -12), carmustine 300 mg/m(2) (day -6), etoposide 100 mg/m(2) twice daily (days -5 to -2), cytarabine 100 mg/m(2) twice daily (days -5 to -2), and melphalan 140 mg/m(2) (day -1; B-BEAM) or rituximab 375 mg/m(2) on days -19 and -12 and the same chemotherapy regimen (R-BEAM). RESULTS Two hundred twenty-four patients were enrolled, with 113 patients randomly assigned to R-BEAM and 111 patients assigned to B-BEAM. Two-year progression-free survival (PFS) rates, the primary end point, were 48.6% (95% CI, 38.6% to 57.8%) for R-BEAM and 47.9% (95% CI, 38.2% to 57%; P = .94) for B-BEAM, and the 2-year overall survival (OS) rates were 65.6% (95% CI, 55.3% to 74.1%) for R-BEAM and 61% (95% CI, 50.9% to 69.9%; P = .38) for B-BEAM. The 100-day treatment-related mortality rates were 4.1% (95% CI, 0.2% to 8.0%) for R-BEAM and 4.9% (95% CI, 0.8% to 9.0%; P = .97) for B-BEAM. The maximum mucositis score was higher in the B-BEAM arm (0.72) compared with the R-BEAM arm (0.31; P < .001). CONCLUSION The B-BEAM and R-BEAM regimens produced similar 2-year PFS and OS rates for patients with chemotherapy-sensitive relapsed DLBCL. No differences in toxicities other than mucositis were noted.
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Affiliation(s)
- Julie M Vose
- Section of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE 68198-7680, USA.
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20
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Wildes TM, Farrington L, Yeung CCS, Harrington A, Foyil KV, Kreisel F, Bartlett N, Fenske T. Hyper-CVAD and rituximab-hyperCVAD in Burkitt lymphoma (BL): A multi-institutional experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18541] [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: 11/20/2022] Open
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21
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Abstract
The implementation of a remote cardiac rehabilitation service to educate people about heart disease is currently under way in northern Alberta. Twenty per cent of patients in the catchment area live in remote areas outside the regional centre and are faced with the usual difficulties of attending urban health-care programmes. The availability of the remote cardiac rehabilitation service enables patients to receive the same rehabilitation benefits as their urban counterparts.
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Affiliation(s)
- I Henderson
- Glenrose Rehabilitation Hospital, Edmonton, Canada
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22
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Abstract
OBJECTIVE Recent studies have suggested that chronic infections may be a risk factor for coronary artery disease. The aim of this study was to determine whether Helicobacter pylori (H. pylori) infection was an independent risk factor for coronary artery disease. METHODS A total of 179 patients undergoing coronary angiography for suspected coronary artery disease were prospectively studied. Angiograms were read by experienced invasive cardiologists blinded to the results of H. pylori serology, which was determined by a validated multiwell ELISA assay. RESULTS A total of 121 patients (68%) had evidence of coronary artery disease, whereas 58 patients (32%) had normal coronary angiograms. Of the 121 patients with coronary artery disease, 29 had single vessel disease, 39 had double vessel disease, and 53 had triple vessel disease, respectively. There was no significant difference in seroprevalence of H. pylori infection in patients with and without coronary artery disease (p = 0.63). The odds ratio (after adjustment for other known risk factors) for coronary artery disease in H. pylori-infected subjects was 0.45 (95% CI = 0.15, 1.37; p = 0.107). In patients with coronary artery disease, H. pylori infection did not increase the likelihood of severe disease (odds ratio for triple vessel disease = 0.53; 95% CI 0.18, 1.60; p = 0.201). CONCLUSION H. pylori infection rates are similar in patients with normal and abnormal coronary arteries, and infection with H. pylori is not an independent risk factor for coronary artery disease. In patients who have coronary artery disease, H. pylori infection is not a risk factor for more severe disease. These data argue against a causal role for H. pylori in the pathogenesis of coronary artery disease.
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Affiliation(s)
- A Khurshid
- Department of Gastroenterology, University of Wisconsin, Milwaukee, USA
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