101
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Chakraborty R, Liu HD, Rybicki L, Tomer J, Khouri J, Dean RM, Faiman BM, Kalaycio M, Samaras CJ, Majhail NS, Valent J. Progression with clinical features is associated with worse subsequent survival in multiple myeloma. Am J Hematol 2019; 94:439-445. [PMID: 30663805 DOI: 10.1002/ajh.25415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/26/2018] [Accepted: 01/07/2019] [Indexed: 11/06/2022]
Abstract
Response rate and survival in multiple myeloma (MM) has improved in the era of proteasome inhibitors and immunomodulatory drugs. However, most patients eventually relapse with biochemical progression (BP) alone or with clinical features of end-organ damage (CP: clinical progression), without or without extramedullary (EM) disease. We conducted a retrospective cohort study of 252 patients with MM experiencing first relapse (time, T0 ) to evaluate survival following CP with and without EM as a function of BP. Patients were divided into three groups: BP (n = 134; 53%), CP/EM- (n = 87; 35%) and CP/EM+ (n = 31; 12%). The median time from diagnosis to T0 was significantly shorter in CP/EM+ compared to CP/EM- and BP groups (13 vs 25 vs 25 months; P < 0.001). The incidence of abnormal metaphase cytogenetics at diagnosis was significantly higher in CP/EM+ compared to CP/EM- and BP groups (46% vs 18% vs 11% respectively; P < 0.001). At a median follow-up of 26 months from T0 , median overall survival was 50, 19 and 10 months for BP, CP/EM- and CP/EM+ groups, respectively (P < 0.001). On multivariable analysis, pattern of progression was a significant prognostic factor for OS (HR for CP/EM- vs BP: 3.6; CP/EM+ vs BP: 8.7 and CP/EM+ vs CP/EM-: 2.42; P < 0.001 for all comparisons), along with age at T0 . In conclusion, progression pattern is an important prognostic factor in the current era, with subsequent survival being dismal in patients with end-organ damage or EM disease at relapse. Clinical trials in relapsed MM should consider reporting patterns of progression at baseline to ensure balance between study arms.
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Affiliation(s)
- Rajshekhar Chakraborty
- Taussig Cancer Center, Department of Hematology and Medical Oncology, Cleveland Clinic Cleveland OH
| | - Hien D. Liu
- Moffitt Cancer Center, Department of Blood and Marrow Transplant and Cellular Immunotherapy Tampa FL
| | - Lisa Rybicki
- Taussig Cancer Center, Department of Hematology and Medical Oncology, Cleveland Clinic Cleveland OH
| | - Jacqulyn Tomer
- Taussig Cancer Center, Department of Hematology and Medical Oncology, Cleveland Clinic Cleveland OH
| | - Jack Khouri
- Taussig Cancer Center, Department of Hematology and Medical Oncology, Cleveland Clinic Cleveland OH
| | - Robert M. Dean
- Taussig Cancer Center, Department of Hematology and Medical Oncology, Cleveland Clinic Cleveland OH
| | - Beth M. Faiman
- Taussig Cancer Center, Department of Hematology and Medical Oncology, Cleveland Clinic Cleveland OH
| | - Matt Kalaycio
- Taussig Cancer Center, Department of Hematology and Medical Oncology, Cleveland Clinic Cleveland OH
| | - Christy J. Samaras
- Taussig Cancer Center, Department of Hematology and Medical Oncology, Cleveland Clinic Cleveland OH
| | - Navneet S. Majhail
- Taussig Cancer Center, Department of Hematology and Medical Oncology, Cleveland Clinic Cleveland OH
| | - Jason Valent
- Taussig Cancer Center, Department of Hematology and Medical Oncology, Cleveland Clinic Cleveland OH
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102
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Mukhija D, Savani M, Shaikh S, Shah S, Rybicki L, Winter A, Jagadeesh D, Gerds AT, Dean RM, Wilke C, Sobecks RM, Pohlman B, Bolwell B, Kalaycio ME, Hamilton BK, Majhail NS, Hill BT, Bachanova V. Post-Transplant Radiation Had No Impact on Survival in Patients with Refractory or Relapsed Diffuse Large B-Cell Lymphoma. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.825] [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: 12/01/2022]
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103
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Mathanda R, Hamilton BK, Rybicki L, Advani AS, Bolwell B, Flagg A, Hanna R, Kalaycio ME, Sobecks RM, Majhail NS, Rotz SJ. Time to Transplantation (TTT) for Acute Myeloid Leukemia (AML) in First Complete Remission (CR1) Is Comparable Among Adolescent and Young Adults (AYAs) and Older Adults. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.409] [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: 12/01/2022]
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104
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Ferraro CS, Bernhard L, Corrigan D, Starn J, Hodgeman B, Elberson J, Winslow V, Colver A, Dabney J, Lawrence C, Coffman J, Majhail NS, Hamilton BK. Implementing Recommended Long Term Follow up Screening and Preventive Practices in an Allogeneic Hematopoietic Cell Transplant Survivorship Clinic. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.179] [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: 10/27/2022]
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105
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Bernhard L, Coffman J, Elberson J, Hodgeman B, Starn J, Winners S, Winslow V, Rasmussen P, Majhail NS. Pilot Study of Home Vitals and Activity Monitoring for Allogeneic Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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106
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Salit RB, Lee SJ, Burns LJ, Shaw BE, Nakano C, Majhail NS, Bhatt NS, Wood WA, Syrjala KL. Guidelines and Support for Return to Work after Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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107
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Patel SS, Hamilton BK, Rybicki L, Thomas D, Emrick A, Nazha A, Mukherjee S, Advani AS, Carraway H, Pohlman B, Bolwell B, Dean RM, Gerds AT, Hanna R, Kalaycio ME, Zhang A, Sekeres MA, Maciejewski J, Majhail NS, Askar MZ, Sobecks RM. Risk Factors for Early Relapse after Allogeneic Hematopoietic Cell Transplantation in Myelodysplastic Syndrome. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.403] [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: 10/27/2022]
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108
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Ferraro CS, Bernhard L, Coffman J, Corrigan D, Majhail NS, Hamilton BK. Patient Reported Review of Symptoms in Survivorship Clinic. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.202] [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: 10/27/2022]
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109
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Hill BT, Rybicki L, Urban TA, Lucerna M, Jagadeesh D, Gerds AT, Dean RM, Sobecks RM, Pohlman B, Bolwell B, Kalaycio ME, Hamilton BK, Copelan EA, Majhail NS. Pharmacokinetic-Guided Therapeutic Dose Monitoring (TDM) of Busulfan Reduces Relapse of Non-Hodgkin Lymphoma (NHL) Patients Undergoing Autologous Stem Cell Transplantation (ASCT). Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.103] [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: 10/27/2022]
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110
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Chakraborty R, Rybicki L, Anwer F, Dean RM, Hamilton BK, Jagadeesh D, Kalaycio ME, Sobecks RM, Valent J, Majhail NS. Conditional Survival in Patients with Multiple Myeloma Undergoing Upfront Autologous Stem Cell Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.803] [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: 12/01/2022]
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111
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Hong S, Rybicki L, Corrigan D, Dabney J, Hamilton BK, Kalaycio M, Lawrence C, McLellan L, Sobecks R, Lee SJ, Majhail NS. Psychosocial Assessment of Candidates for Transplant (PACT) as a tool for psychological and social evaluation of allogeneic hematopoietic cell transplantation recipients. Bone Marrow Transplant 2019; 54:1443-1452. [PMID: 30696998 DOI: 10.1038/s41409-019-0455-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/29/2018] [Accepted: 01/07/2019] [Indexed: 01/22/2023]
Abstract
Psychosocial Assessment of Candidates for Transplant (PACT) is a tool originally developed to address psychosocial risks in solid organ transplant recipients and has the potential for application to hematopoietic cell transplantation (HCT) recipients. In a retrospective cohort study, we reviewed 404 adult allogeneic HCT cases from 2003 to 2014 to identify predictors of adverse psychosocial status as determined by PACT. Final PACT rating was poor/borderline (score 0-1) in 5%, acceptable (score 2) in 22%, good (score 3) in 44%, and excellent (score 4) in 29% recipients. In multivariable regression, higher PACT score was associated with White race (odds ratio [OR] 2.95, P < 0.001), having a related donor (OR 1.61, P = 0.015), and a higher quality of life score (OR 1.22/ 10-point increase in FACT-BMT total score, P < 0.001). PACT score correlated with all quality of life subscales. The final PACT score was associated with non-relapse mortality (HR 0.82/ 1-point increase, p = 0.03) in multivariable analysis that considered patient and disease factors, but not in models that also included transplant-related factors and performance status. PACT score was not associated with overall survival. PACT can be considered as part of a comprehensive psychosocial assessment for identifying patients who may require additional resources around allogeneic HCT.
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Affiliation(s)
- Sanghee Hong
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Lisa Rybicki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Donna Corrigan
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jane Dabney
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Betty K Hamilton
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Matt Kalaycio
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Christine Lawrence
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Linda McLellan
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ronald Sobecks
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
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112
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Askar M, Sayer D, Wang T, Haagenson M, Spellman SR, Lee SJ, Madbouly A, Fleischhauer K, Hsu KC, Verneris MR, Thomas D, Zhang A, Sobecks RM, Majhail NS. Analysis of Single Nucleotide Polymorphisms in the Gamma Block of the Major Histocompatibility Complex in Association with Clinical Outcomes of Hematopoietic Cell Transplantation: A Center for International Blood and Marrow Transplant Research Study. Biol Blood Marrow Transplant 2018; 25:664-672. [PMID: 30537553 DOI: 10.1016/j.bbmt.2018.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/06/2018] [Indexed: 01/08/2023]
Abstract
HLA haplotype mismatches have been associated with an elevated risk of acute graft-versus-host disease (aGVHD) in patients undergoing HLA-matched unrelated donor (URD) hematopoietic cell transplantation (HCT). The gamma block (GB) is located in the central MHC region between beta and delta blocks (encoding HLA-B and -C and HLA-DQ and -DR antigens, respectively) and contains numerous inflammatory and immune regulatory genes, including Bf, C2, and C4 genes. A single-center study showed that mismatches in SNPs c.2918+98G, c.3316C, and c.4385C in the GB block (C4 SNPs) were associated with higher risk of grade III-IV aGVHD. We investigated the association of GB SNP (GBS) mismatches with outcomes after 10/10 and 9/10 URD HCT (n = 714). The primary outcome was acute GVHD. Overall survival, disease-free survival, transplantation-related mortality, relapse, chronic GVHD, and engraftment were also analyzed. DNA samples were GBS genotyped by identifying 338 SNPs across 20 kb using the Illumina NGS platform. The overall 100-day incidence of aGVHD grade II-IV and II-IV were 41% and 17%, respectively. The overall incidence of matching at all GBSs tested and at the C4 SNPs were 23% and 81%, respectively. Neither being matched across all GB SNPs tested (versus mismatched) nor having a higher number of GBS mismatches was associated with transplantation outcomes. There was no association between C4 SNP mismatches and outcomes except for an unexpected significant association between having 2 C4 SNP mismatches and a higher hazard ratio (HR) for relapse (association seen in 15 patients only; HR, 3.38, 95% confidence interval, 1.75 to 6.53; P = .0003). These data do not support the hypothesis that mismatching at GB is associated with outcomes after HCT.
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Affiliation(s)
- Medhat Askar
- Baylor University Medical Center, Transplant Immunology, Dallas, Texas
| | - David Sayer
- Illumina, Conexio Genomics, Fremantle, Australia
| | - Tao Wang
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Haagenson
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota.
| | | | - Abeer Madbouly
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Katharina Fleischhauer
- Institute for Experimental Cellular Therapy, Essen University Hospital Essen, Essen, Germany
| | | | - Michael R Verneris
- Children's Hospital Colorado, University of Colorado School of Medicine, Pediatrics-Heme/Onc and Bone Marrow Transplantation, Aurora, Colorado
| | - Dawn Thomas
- Cleveland Clinic Foundation, Cleveland, Hematology and Medical Oncology, Ohio
| | - Aiwen Zhang
- Cleveland Clinic Foundation, Cleveland, Hematology and Medical Oncology, Ohio
| | - Ronald M Sobecks
- Cleveland Clinic Foundation, Cleveland, Hematology and Medical Oncology, Ohio
| | - Navneet S Majhail
- Cleveland Clinic Foundation, Cleveland, Hematology and Medical Oncology, Ohio
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113
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Majhail NS, Murphy E, Laud P, Preussler JM, Denzen EM, Abetti B, Adams A, Besser R, Burns LJ, Cerny J, Drexler R, Hahn T, Idossa L, Jahagirdar B, Kamani N, Loren A, Mattila D, McGuirk J, Moore H, Reynolds J, Saber W, Salazar L, Schatz B, Stiff P, Wingard JR, Syrjala KL, Baker KS. Randomized controlled trial of individualized treatment summary and survivorship care plans for hematopoietic cell transplantation survivors. Haematologica 2018; 104:1084-1092. [PMID: 30514795 PMCID: PMC6518896 DOI: 10.3324/haematol.2018.203919] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/23/2018] [Indexed: 12/31/2022] Open
Abstract
Survivorship Care Plans (SCPs) may facilitate long-term care for cancer survivors, but their effectiveness has not been established in hematopoietic cell transplantation recipients. We evaluated the impact of individualized SCPs on patient-reported outcomes among transplant survivors. Adult (≥18 years at transplant) survivors who were 1-5 years post transplantation, proficient in English, and without relapse or secondary cancers were eligible for this multicenter randomized trial. SCPs were developed based on risk-factors and treatment exposures using patient data routinely submitted by transplant centers to the Center for International Blood and Marrow Transplant Research and published guidelines for long-term follow up of transplant survivors. Phone surveys assessing patient-reported outcomes were conducted at baseline and at 6 months. The primary end point was confidence in survivorship information, and secondary end points included cancer and treatment distress, knowledge of transplant exposures, health care utilization, and health-related quality of life. Of 495 patients enrolled, 458 completed a baseline survey and were randomized (care plan=231, standard care=227); 200 (87%) and 199 (88%) completed the 6-month assessments, respectively. Patients’ characteristics were similar in the two arms. Participants on the care plan arm reported significantly lower distress scores at 6 months and an increase in the Mental Component Summary quality of life score assessed by the Short Form 12 (SF-12) instrument. No effect was observed on the end point of confidence in survivorship information or other secondary outcomes. Provision of individualized SCPs generated using registry data was associated with reduced distress and improved mental domain of quality of life among 1-5 year hematopoietic cell transplantation survivors. Trial registered at clinicaltrials.gov 02200133.
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Affiliation(s)
| | | | | | - Jaime M Preussler
- National Marrow Donor Program/Be The Match, Minneapolis, MN.,Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Ellen M Denzen
- National Marrow Donor Program/Be The Match, Minneapolis, MN.,Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | - Alexia Adams
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - RaeAnne Besser
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, MN.,Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Jan Cerny
- UMass Memorial Medical Center, Worcester, MA
| | - Rebecca Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Theresa Hahn
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lensa Idossa
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | | | | | | | - Deborah Mattila
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | - Heather Moore
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | | | - Wael Saber
- Medical College of Wisconsin, Milwaukee, WI.,Center for International Blood and Marrow Transplant Research, Milwaukee, WI
| | | | | | | | | | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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114
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Horwitz ME, Wease S, Blackwell B, Valcarcel D, Frassoni F, Boelens JJ, Nierkens S, Jagasia M, Wagner JE, Kuball J, Koh LP, Majhail NS, Stiff PJ, Hanna R, Hwang WYK, Kurtzberg J, Cilloni D, Freedman LS, Montesinos P, Sanz G. Phase I/II Study of Stem-Cell Transplantation Using a Single Cord Blood Unit Expanded Ex Vivo With Nicotinamide. J Clin Oncol 2018; 37:367-374. [PMID: 30523748 PMCID: PMC6368416 DOI: 10.1200/jco.18.00053] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Increasing the number of hematopoietic stem and progenitor cells within an umbilical cord blood (UCB) graft shortens the time to hematopoietic recovery after UCB transplantation. In this study, we assessed the safety and efficacy of a UCB graft that was expanded ex vivo in the presence of nicotinamide and transplanted after myeloablative conditioning as a stand-alone hematopoietic stem-cell graft. METHODS Thirty-six patients with hematologic malignancies underwent transplantation at 11 sites. RESULTS The cumulative incidence of neutrophil engraftment at day 42 was 94%. Two patients experienced secondary graft failure attributable to viral infections. Hematopoietic recovery was compared with that observed in recipients of standard UCB transplantation as reported to the Center for International Blood and Marrow Transplant Research (n = 146). The median time to neutrophil recovery was 11.5 days (95% CI, 9 to 14 days) for recipients of nicotinamide-expanded UCB and 21 days (95% CI, 20 to 23 days) for the comparator ( P < .001). The median time to platelet recovery was 34 days (95% CI, 32 to 42 days) and 46 days (95% CI, 42 to 50 days) for the expanded and the comparator cohorts, respectively ( P < .001). The cumulative incidence of grade 2 to 4 acute graft-versus-host disease (GVHD) at day 100 was 44%, and grade 3 and 4 acute GVHD at day 100 was 11%. The cumulative incidence at 2 years of all chronic GVHD was 40%, and moderate/severe chronic GVHD was 10%. The 2-year cumulative incidences of nonrelapse mortality and relapse were 24% and 33%, respectively. The 2-year probabilities of overall and disease-free survival were 51% and 43%, respectively. CONCLUSION UCB expanded ex vivo with nicotinamide shortens median neutrophil recovery by 9.5 days (95% CI, 7 to 12 days) and median platelet recovery by 12 days (95% CI, 3 to 16.5 days). This trial establishes feasibility, safety, and efficacy of an ex vivo expanded UCB unit as a stand-alone graft.
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Affiliation(s)
| | | | | | | | | | | | - Stefan Nierkens
- 5 University Medical Center Utrecht, Utrecht, the Netherlands
| | - Madan Jagasia
- 6 Vanderbilt University Medical Center, Nashville, TN
| | | | - Jurgen Kuball
- 5 University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | - Pau Montesinos
- 14 Hospital Universitario y Politécnic de La Fe, Valencia, Spain
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115
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Chakraborty R, Sidana S, Shah GL, Scordo M, Hamilton BK, Majhail NS. Patient-Reported Outcomes with Chimeric Antigen Receptor T Cell Therapy: Challenges and Opportunities. Biol Blood Marrow Transplant 2018; 25:e155-e162. [PMID: 30500439 DOI: 10.1016/j.bbmt.2018.11.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 09/20/2018] [Accepted: 11/21/2018] [Indexed: 12/16/2022]
Abstract
Patient-reported outcomes (PROs) are an important tool to assess the impact of a new therapy on symptom burden and health-related quality of life (HRQoL). Chimeric antigen receptor T (CAR-T) cell therapies have been approved for use in relapsed or refractory leukemia and lymphoma based on promising efficacy in clinical trials. However, data are lacking on patient-reported toxicity and impact on HRQoL. This review provides an overview of the incorporation of PROs in CAR-T cell therapy and the specific challenges in this context. The first step is to demonstrate feasibility of PRO monitoring in the acute phase after CAR-T cell infusion. Apart from core PRO domains like physical functioning, disease-related symptoms, and symptomatic adverse effects, important measures to consider are cognitive functioning and financial toxicity. Because there are no validated PRO instruments in the setting of CAR-T cell therapy, universally validated measures like Patient-Reported Outcomes Measurement Information System (PROMIS) could be considered, which is also recommended in the setting of hematopoietic stem cell transplantation. Given the timeline of toxicities with CAR-T cell therapy, PRO instruments should be administered at baseline and at least weekly in the first 30 days. Subsequently, frequent monitoring of PROs in the first year might be helpful in identifying short- and intermediate-term toxicities, functional limitations, and neuropsychiatric effects. The major potential challenge in acute phase would be missing data when patients develop severe cytokine release syndrome or neurotoxicity. Designing a strategy for handling missing data is crucial. The long-term safety of CAR-T cell therapy is not well characterized because of short follow-up in most studies reported thus far. PROs should be measured at least yearly after the first year to identify potential late effects like cognitive deficit or autoimmune manifestations. Collaboration between institutions performing cellular therapy and engagement with patients, clinicians, and statisticians with expertise in PROs are crucial for setting a comprehensive agenda on integration of PROs with CAR-T cell therapy.
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Affiliation(s)
| | - Surbhi Sidana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
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116
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Radivoyevitch T, Dean RM, Shaw BE, Brazauskas R, Tecca HR, Molenaar RJ, Battiwalla M, Savani BN, Flowers MED, Cooke KR, Hamilton BK, Kalaycio M, Maciejewski JP, Ahmed I, Akpek G, Bajel A, Buchbinder D, Cahn JY, D’Souza A, Daly A, DeFilipp Z, Ganguly S, Hamadani M, Hayashi RJ, Hematti P, Inamoto Y, Khera N, Kindwall-Keller T, Landau H, Lazarus H, Majhail NS, Marks DI, Olsson RF, Seo S, Steinberg A, William BM, Wirk B, Yared JA, Aljurf M, Abidi MH, Allewelt H, Beitinjaneh A, Cook R, Cornell RF, Fay JW, Hale G, Chakrabarty JH, Jodele S, Kasow KA, Mahindra A, Malone AK, Popat U, Rizzo JD, Schouten HC, Warwick AB, Wood WA, Sekeres MA, Litzow MR, Gale RP, Hashmi SK. Risk of acute myeloid leukemia and myelodysplastic syndrome after autotransplants for lymphomas and plasma cell myeloma. Leuk Res 2018; 74:130-136. [PMID: 30055822 PMCID: PMC6219911 DOI: 10.1016/j.leukres.2018.07.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 05/21/2018] [Revised: 06/26/2018] [Accepted: 07/17/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Exposures to DNA-damaging drugs and ionizing radiations increase risks of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). METHODS 9028 recipients of hematopoietic cell autotransplants (1995-2010) for Hodgkin lymphoma (HL; n = 916), non-Hodgkin lymphoma (NHL; n = 3546) and plasma cell myeloma (PCM; n = 4566), reported to the CIBMTR, were analyzed for risk of subsequent AML or MDS. RESULTS 335 MDS/AML cases were diagnosed posttransplant (3.7%). Variables associated with an increased risk for AML or MDS in multivariate analyses were: (1) conditioning with total body radiation versus chemotherapy alone for HL (HR = 4.0; 95% confidence interval [1.4, 11.6]) and NHL (HR = 2.5 [1.1, 2.5]); (2) ≥3 versus 1 line of chemotherapy for NHL (HR = 1.9 [1.3, 2.8]); and (3) subjects with NHL transplanted in 2005-2010 versus 1995-1999 (HR = 2.1 [1.5, 3.1]). Using Surveillance, Epidemiology and End Results (SEER) data, we found risks for AML/MDS in HL, NHL and PCM to be 5-10 times the background rate. In contrast, relative risks were 10-50 for AML and approximately 100 for MDS in the autotransplant cohort. CONCLUSIONS There are substantial risks of AML and MDS after autotransplants for HL, NHL and PCM.
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Affiliation(s)
- Tomas Radivoyevitch
- Dept. of Translational Hematology & Oncology Research, Cleveland Clinic Foundation, Cleveland, OH
| | - Robert M. Dean
- Dept. of Translational Hematology & Oncology Research, Cleveland Clinic Foundation, Cleveland, OH
| | - Bronwen E. Shaw
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Ruta Brazauskas
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Heather R. Tecca
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Remco J. Molenaar
- Dept. of Translational Hematology & Oncology Research, Cleveland Clinic Foundation, Cleveland, OH
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Minoo Battiwalla
- Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Bipin N. Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Mary E. D. Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kenneth R. Cooke
- Pediatric Blood and Marrow Transplantation Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Betty K. Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Matt Kalaycio
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | | | - Ibrahim Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Görgün Akpek
- Stem Cell Transplantation and Cell Therapy, Rush University Medical Center, Chicago, IL
| | - Ashish Bajel
- Royal Melbourne Hospital City Campus, Melbourne, Australia
| | - David Buchbinder
- Division of Pediatrics Hematology, Children’s Hospital of Orange County, Orange, CA
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Anita D’Souza
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, AB, Canada
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, University of Kansas Medical Center, Kansas City, KS
| | - Mehdi Hamadani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Robert J. Hayashi
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Peiman Hematti
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | - Heather Landau
- Bone Marrow Transplant Service, Division of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hillard Lazarus
- Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | | | - David I. Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Richard F. Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Sachiko Seo
- Department of Hematology & Oncology; National Cancer Research Center East, Chiba, Japan
| | - Amir Steinberg
- Department of Hematology-Oncology, Mount Sinai Hospital, New York, NY
| | | | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA
| | - Jean A. Yared
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital,, Riyadh, Saudi Arabia
| | - Muneer H. Abidi
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | | | - Rachel Cook
- Oregon Health and Science University, Portland, OR
| | - Robert F. Cornell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Gregory Hale
- Department of Hematology/Oncology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | | | - Sonata Jodele
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Anuj Mahindra
- Scripps Blood & Marrow Transplant Program, La Jolla, CA
| | - Adriana K. Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - J. Douglas Rizzo
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Harry C. Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
| | - Anne B. Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - William A. Wood
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mikkael A. Sekeres
- Dept. of Translational Hematology & Oncology Research, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Robert P. Gale
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Shahrukh K. Hashmi
- Department of Oncology, King Faisal Specialist Hospital,, Riyadh, Saudi Arabia
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Patel SS, Majhail NS. Social Media and Hematopoietic Cell Transplantation: a Review of Online Resources and Communities. Curr Hematol Malig Rep 2018; 13:576-580. [DOI: 10.1007/s11899-018-0487-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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118
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Denzen EM, Preussler JM, Murphy EA, Baker KS, Burns LJ, Foster J, Idossa L, Moore HK, Payton TJ, Haven D, Jahagirdar B, Kamani N, Rizzo JD, Salazar L, Schatz BA, Syrjala KL, Wingard JR, Majhail NS. Tailoring a Survivorship Care Plan: Patient and Provider Preferences for Recipients of Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 25:562-569. [PMID: 30315940 DOI: 10.1016/j.bbmt.2018.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
This study aimed to develop a survivorship care plan (SCP) that can be individualized to facilitate long-term follow-up care of hematopoietic cell transplantation (HCT) survivors. A sample SCP was developed that included 2 documents: a treatment summary and preventive care recommendations that combined data on treatment exposures routinely submitted by HCT centers to the Center for International Blood and Marrow Transplant Research (CIBMTR) with long-term follow-up guidelines. Focus groups were conducted by phone to characterize the critical patient-centered elements of the SCP. Focus group eligibility criteria included (1) adult patients >1 year post-HCT and their caregivers (3 groups; n = 22), (2) HCT physicians and advanced practice providers (APPs) (2 groups; n = 14), (3) HCT nurses and social workers (4 groups; n = 17), and (4) community health care professionals (3 groups; n = 24). Transcripts were analyzed for saturation of key themes using NVivo 10 software. Patients and caregivers suggested combining the treatment summary and care guidelines into a single document. They also requested sections on sexual and emotional health and the immune system. Providers wanted the treatment summary to focus only on what they absolutely must know. Themes were similar across healthcare professionals, although screening for psychosocial issues was emphasized more by the nurses and social workers. All preferred to receive the SCP electronically; however, hardcopy was considered necessary for some patients. All felt that the SCP would facilitate appropriate post-HCT care. This study highlights the need for an SCP instrument to facilitate HCT survivorship care. Furthermore, it demonstrates the feasibility and value of engaging HCT recipients, caregivers, and providers in developing an SCP. Their feedback was incorporated into a final SCP that was subsequently tested in a randomized trial.
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Affiliation(s)
- Ellen M Denzen
- National Marrow Donor Program/Be The Match, Minneapolis, MN; Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Jaime M Preussler
- National Marrow Donor Program/Be The Match, Minneapolis, MN; Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | | | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, MN; Center for International Blood and Marrow Transplant Research, Minneapolis, MN.
| | - Jackie Foster
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Lensa Idossa
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | | | - Tammy J Payton
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Darlene Haven
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | | | | | - J Douglas Rizzo
- Medical College of Wisconsin, Milwaukee, WI; Center for International Blood and Marrow Transplant Research, Milwaukee, WI
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Khera N, Hamilton BK, Pidala JA, Wood WA, Wu V, Voutsinas J, Onstad L, Alousi AM, Broady R, Chen GL, Arora M, Cutler C, Flowers ME, Ganetsky A, Jagasia M, McCarthy PL, Sarantopoulos S, Abel GA, Majhail NS, Lee SJ. Employment, Insurance, and Financial Experiences of Patients with Chronic Graft-versus-Host Disease in North America. Biol Blood Marrow Transplant 2018; 25:599-605. [PMID: 30296479 DOI: 10.1016/j.bbmt.2018.09.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
Understanding the socioeconomic impact of chronic graft-versus-host disease (GVHD) on affected patients is essential to help improve their overall well-being. Using data from the Chronic GVHD Consortium, we describe the insurance, employment, and financial challenges faced by these patients and the factors associated with the ability to work/attend school and associated financial burdens. A 15-item cross-sectional questionnaire designed to measure financial concerns, income, employment, and insurance was completed by 190 patients (response rate, 68%; 10 centers) enrolled on a multicenter Chronic GVHD Consortium Response Measures Validation Study. Multivariable logistic regression models examined the factors associated with financial burden and ability to work/attend school. The median age of respondents was 56years, and 87% of the patients were white. A higher proportion of nonrespondents had lower income before hematopoietic cell transplantation and less than a college degree. All but 1 patient had insurance, 34% had faced delayed/denied insurance coverage for chronic GVHD treatments, and 66% reported a financial burden. Patients with a financial burden had greater depression/anxiety and difficulty sleeping. Nonwhite race, lower mental functioning, and lower activity score were associated with a greater likelihood of financial burden. Younger age, early risk disease, and higher mental functioning were associated with a greater likelihood of being able to work/attend school. In this multicenter cohort of patients with chronic GVHD, significant negative effects on finances were observed even with health insurance coverage. Future research should investigate potential interventions to provide optimal and affordable care to at-risk patients and prevent long-term adverse financial outcomes in this vulnerable group.
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Affiliation(s)
- Nandita Khera
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Betty K Hamilton
- Blood and Marrow Transplantation, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph A Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - William A Wood
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Vicky Wu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jenna Voutsinas
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lynn Onstad
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Amin M Alousi
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Raewyn Broady
- Leukemia/Bone Marrow Transplant Program of British Columbia, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - George L Chen
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Mukta Arora
- Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Corey Cutler
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Alex Ganetsky
- Hematology/BMT, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madan Jagasia
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Philip L McCarthy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Gregory A Abel
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Navneet S Majhail
- Blood and Marrow Transplantation, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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120
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Duncan CN, Brazauskas R, Huang J, Shaw BE, Majhail NS, Savani BN, Flowers MED, Battiwalla M, Beebe K, Dietz AC, Dvorak CC, Giller R, Jacobsohn DA, Kletzel M, Martin PL, Nemecek ER, Nuechterlein B, Talano JA, Pulsipher MA, Baker KS. Late cardiovascular morbidity and mortality following pediatric allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2018; 53:1278-1287. [PMID: 29581480 PMCID: PMC6158112 DOI: 10.1038/s41409-018-0155-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/19/2018] [Accepted: 02/16/2018] [Indexed: 01/19/2023]
Abstract
We analyzed late cardiovascular outcomes of 661 patients who survived at least 2 years from hematopoietic cell transplantation for childhood hematologic malignancy between 1995 and 2008. Center for International Blood and Marrow Transplant Research data was supplemented with surveys focused on cardiotoxicity and potential risk factors. The median duration of follow-up was 97 months (range 24-230). 4.2% of survivors experienced at least one of the primary outcomes including coronary artery disease (0.2%), cerebrovascular accident (0.6%), cardiomyopathy (3%), and cardiac-related death (0.5%). Patients who received anthracycline chemotherapy (HR 4.67, p = 0.036) or cranial or chest radiation (HR 5.58, p < 0.0001; HR 2.18, p = 0.0087) were at increased risk for developing one of the primary outcomes. Dyslipidemia was diagnosed in 18% of survivors. Pre-transplant anthracycline (HR 1.74, p < 0.0001) and chest radiation (HR 1.34, p = 0.0371) were risk factors for dyslipidemia. Overweight/obese body mass status was present in 63% of patients at baseline, 65% at 2 years, and 52% at most recent evaluation. Diabetes was diagnosed in 7% of subjects. In conclusion, severe cardiovascular complications were infrequently reported. The incidence of risk factors including obesity and dyslipidemia were significant and will likely increase the risk of cardiovascular disease over time in transplant survivors.
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Affiliation(s)
- Christine N Duncan
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA.
| | - Ruta Brazauskas
- Center of International Blood and Marrow Transplant Research, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jiaxing Huang
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bronwen E Shaw
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Navneet S Majhail
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Minoo Battiwalla
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Kristen Beebe
- Phoenix Children's Center for Cancer and Blood Disorders, Phoenix, AZ, USA
| | - Andrew C Dietz
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, and Bone Marrow Transplantation, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Roger Giller
- University of Colorado Cancer Center, Aurora, CO, USA
| | - David A Jacobsohn
- Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC, USA
| | - Morris Kletzel
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Paul L Martin
- Pediatric Division of Blood and Marrow Transplantation, Duke School of Medicine, Durham, NC, USA
| | - Eneida R Nemecek
- Oregon Health & Science University, Knight Cancer Institute, Portland, OR, USA
| | | | - Julie-An Talano
- Department of Pediatric Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael A Pulsipher
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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121
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Chhabra S, Liu Y, Hemmer MT, Costa L, Pidala JA, Couriel DR, Alousi AM, Majhail NS, Stuart RK, Kim D, Ringden O, Urbano-Ispizua A, Saad A, Savani BN, Cooper B, Marks DI, Socie G, Schouten HC, Schoemans H, Abdel-Azim H, Yared J, Cahn JY, Wagner J, Antin JH, Verdonck LF, Lehmann L, Aljurf MD, MacMillan ML, Litzow MR, Solh MM, Qayed M, Hematti P, Kamble RT, Vij R, Hayashi RJ, Gale RP, Martino R, Seo S, Hashmi SK, Nishihori T, Teshima T, Gergis U, Inamoto Y, Spellman SR, Arora M, Hamilton BK. Comparative Analysis of Calcineurin Inhibitor-Based Methotrexate and Mycophenolate Mofetil-Containing Regimens for Prevention of Graft-versus-Host Disease after Reduced-Intensity Conditioning Allogeneic Transplantation. Biol Blood Marrow Transplant 2018; 25:73-85. [PMID: 30153491 DOI: 10.1016/j.bbmt.2018.08.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 06/07/2018] [Accepted: 08/09/2018] [Indexed: 01/11/2023]
Abstract
The combination of a calcineurin inhibitor (CNI) such as tacrolimus (TAC) or cyclosporine (CYSP) with methotrexate (MTX) or with mycophenolate mofetil (MMF) has been commonly used for graft-versus-host disease (GVHD) prophylaxis after reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (alloHCT), but there are limited data comparing efficacy of the 2 regimens. We evaluated 1564 adult patients who underwent RIC alloHCT for acute myelogenous leukemia (AML) and acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), and myelodysplastic syndrome (MDS) from 2000 to 2013 using HLA-identical sibling (matched related donor [MRD]) or unrelated donor (URD) peripheral blood graft and received CYSP or TAC with MTX or MMF for GVHD prophylaxis. Primary outcomes of the study were acute and chronic GVHD and overall survival (OS). The study divided the patient population into 4 cohorts based on regimen: MMF-TAC, MMF-CYSP, MTX-TAC, and MTX-CYSP. In the URD group, MMF-CYSP was associated with increased risk of grade II to IV acute GVHD (relative risk [RR], 1.78; P < .001) and grade III to IV acute GVHD (RR, 1.93; P = .006) compared with MTX-TAC. In the URD group, use of MMF-TAC (versus MTX-TAC) lead to higher nonrelapse mortality. (hazard ratio, 1.48; P = .008). In either group, no there was no difference in chronic GVHD, disease-free survival, and OS among the GVHD prophylaxis regimens. For RIC alloHCT using MRD, there are no differences in outcomes based on GVHD prophylaxis. However, with URD RIC alloHCT, MMF-CYSP was inferior to MTX-based regimens for acute GVHD prevention, but all the regimens were equivalent in terms of chronic GVHD and OS. Prospective studies, targeting URD recipients are needed to confirm these results.
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Affiliation(s)
- Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Ying Liu
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Institute for Health and Society, Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael T Hemmer
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Luciano Costa
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph A Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Daniel R Couriel
- Division of Hematology and Hematologic Malignancies, Utah Blood and Marrow Transplant Program, Salt Lake City, Utah
| | - Amin M Alousi
- Department of Stem Cell Transplantation, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Robert K Stuart
- Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Dennis Kim
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Center, Toronto, Canada
| | - Olle Ringden
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alvaro Urbano-Ispizua
- Department of Hematology, IDIBAPS, Institute of Research Josep Carreras, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brenda Cooper
- Department of Medicine-Hematology and Oncology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Gerard Socie
- Department of Hematology, Hôpital Saint Louis, Paris, France
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, the Netherlands
| | - Helene Schoemans
- Department of Hematology, 26-Department of Pediatrics, University Hospital of Leuven, Leuven, Belgium
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Jean Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - John Wagner
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joseph H Antin
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Leo F Verdonck
- Departmentt of Hematology/Oncology, Isala Clinic, Zwolle, the Netherlands
| | - Leslie Lehmann
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mahmoud D Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Margaret L MacMillan
- University of Minnesota Blood and Marrow Transplant Program, Minneapolis, Minnesota
| | - Mark R Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, Minnesota
| | - Melhem M Solh
- Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Muna Qayed
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Robert P Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Rodrigo Martino
- Divison of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sachiko Seo
- Department of Hematology & Oncology, National Cancer Research Center East, Chiba, Japan
| | - Shahrukh K Hashmi
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia; Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, Minnesota
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Takanori Teshima
- Department of Hematology Kyushu University Hospital, Sapporo, Japan
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Yoshihiro Inamoto
- Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
| | - Betty K Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
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Sullivan KM, Majhail NS, Bredeson C, Carpenter PA, Chatterjee S, Crofford LJ, Georges GE, Nash RA, Pasquini MC, Sarantopoulos S, Storek J, Savani B, St Clair EW. Systemic Sclerosis as an Indication for Autologous Hematopoietic Cell Transplantation: Position Statement from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2018; 24:1961-1964. [PMID: 29953945 DOI: 10.1016/j.bbmt.2018.06.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 06/19/2018] [Indexed: 12/29/2022]
Abstract
Systemic sclerosis is a progressive inflammatory disease that is frequently fatal and has limited treatment options. High-dose chemotherapy with autologous hematopoietic cell transplantation (AHCT) has been evaluated as treatment for this disease in observational studies, multicenter randomized controlled clinical trials, and meta-analyses. On behalf of the American Society for Blood and Marrow Transplantation (ASBMT), a panel of experts in transplantation and rheumatology was convened to review available evidence and make a recommendation on AHCT as an indication for systemic sclerosis. Three randomized trials have compared the efficacy of AHCT with cyclophosphamide only, and all demonstrated benefit for the AHCT arm for their primary endpoint (improvement in the American Scleroderma Stem Cell versus Immune Suppression Trial, event-free survival in Autologous Stem Cell Transplantation International Scleroderma trial, and change in global rank composite score in Scleroderma: Cyclophosphamide or Transplantation trial). AHCT recipients also had better overall survival and a lower rate of disease progression. These findings have been confirmed in subsequent meta-analyses. Based on this high-quality evidence, the ASBMT recommends systemic sclerosis should be considered as a "standard of care" indication for AHCT. Close collaboration between rheumatologists and transplant clinicians is critical for optimizing patient selection and patient outcomes. Transplant centers in the United States are strongly encouraged to report patient and outcomes data to the Center for International Blood and Marrow Transplant Research on their patients receiving AHCT for this indication.
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Affiliation(s)
- Keith M Sullivan
- Department of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina.
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | | | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Soumya Chatterjee
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - George E Georges
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Richard A Nash
- Blood and Marrow Transplant Program, Colorado Blood Cancer Institute, Denver, Colorado
| | - Marcelo C Pasquini
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Stefanie Sarantopoulos
- Department of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Jan Storek
- Blood and Marrow Transplant Program, University of Calgary, Calgary, Alberta, Canada
| | - Bipin Savani
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - E William St Clair
- Department of Rheumatology and Immunology, Duke University School of Medicine, Durham, North Carolina
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123
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Burns LJ, Abbetti B, Arnold SD, Bender J, Doughtie S, El-Jawahiri A, Gee G, Hahn T, Horowitz MM, Johnson S, Juckett M, Krishnamurit L, Kullberg S, LeMaistre CF, Loren A, Majhail NS, Murphy EA, Rizzo D, Roche-Green A, Saber W, Schatz BA, Schmit-Pokorny K, Shaw BE, Syrjala KL, Tierney DK, Ullrich C, Vanness DJ, Wood WA, Denzen EM. Engaging Patients in Setting a Patient-Centered Outcomes Research Agenda in Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:1111-1118. [DOI: 10.1016/j.bbmt.2018.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
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124
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Rahman S, Rybicki LA, Mossad SB, Sobecks RM, Majhail NS. Infectious complications in multiple myeloma (MM) patients receiving autologous hematopoietic cell transplantation (AutoHCT) in the contemporary era. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e20003] [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)
| | | | - Sherif B Mossad
- Cleveland Clinic Foundation, Department of Infectious Diseases,Section of Transplant Infectious Diseases and Transplant Center, Cleveland, OH
| | | | - Navneet S. Majhail
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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125
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Bhella S, Majhail NS, Betcher J, Costa LJ, Daly A, Dandoy CE, DeFilipp Z, Doan V, Gulbis A, Hicks L, Juckett M, Khera N, Krishnan A, Selby G, Shah NN, Stricherz M, Viswabandya A, Bredeson C, Seftel MD. Choosing Wisely BMT: American Society for Blood and Marrow Transplantation and Canadian Blood and Marrow Transplant Group's List of 5 Tests and Treatments to Question in Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2018; 24:909-913. [DOI: 10.1016/j.bbmt.2018.01.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 12/20/2022]
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126
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Mustafa Ali M, Corrigan DM, Rybicki LA, Yurch MA, Cherni K, Liu H, Dean R, Hamilton B, Pohlman B, Andresen S, Kalaycio M, Bolwell BJ, Majhail NS, Sobecks R. Intravenous compared to oral busulfan with cyclophosphamide for autologous hematopoietic cell transplant conditioning for plasma cell myeloma. Hematol Oncol Stem Cell Ther 2018; 11:253-256. [PMID: 29705567 DOI: 10.1016/j.hemonc.2018.03.006] [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: 10/06/2017] [Revised: 03/07/2018] [Accepted: 03/27/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Donna M Corrigan
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Lisa A Rybicki
- Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, United States
| | - Melissa A Yurch
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kelly Cherni
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Hien Liu
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Robert Dean
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Betty Hamilton
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Brad Pohlman
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Steven Andresen
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Matt Kalaycio
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Brian J Bolwell
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Ronald Sobecks
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States.
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127
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Spellecy R, Tarima S, Denzen E, Moore H, Abhyankar S, Dawson P, Foley A, Gersten I, Horwitz M, Idossa L, Joffe S, Kamani N, King R, Lazaryan A, Morris L, Horowitz MM, Majhail NS. Easy-to-Read Informed Consent Form for Hematopoietic Cell Transplantation Clinical Trials: Results from the Blood and Marrow Transplant Clinical Trials Network 1205 Study. Biol Blood Marrow Transplant 2018; 24:2145-2151. [PMID: 29679770 DOI: 10.1016/j.bbmt.2018.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
Because of the complexity of hematopoietic cell transplant trial treatments, informed consent forms are often long and difficult to read. We evaluated a 2-column easy-to-read informed consent (ETRIC) form that incorporates elements of health literacy and readability in participants and centers participating in Blood and Marrow Transplant Clinical Trials Network (BMT CTN) clinical trials. In a randomized study 198 adult patients from 25 centers potentially eligible to participate in 4 BMT CTN interventional trials were randomized to the ETRIC form or a standard consent form for that trial. Both forms were written at no more than an eighth-grade reading level. The primary endpoint was objective comprehension score on the Quality of Informed Consent, part A (QuIC-A) instrument. In a parallel evaluation study, 2 moderators conducted semistructured interviews of 49 investigators, research staff, and institutional review board (IRB) members at 9 BMT CTN trial sites. The mean QuIC-A scores were comparable in 152 patients (77%) assessable for the primary endpoint (ETRIC form, 80.5; standard form, 81.8; P = .37). In regression analysis there was no significant association between the consent type and QuIC-A score. In the evaluation study dominant themes identified on qualitative analyses included general comfort and willingness to use the ETRIC template and that its formatting and layout enhancements would offer additional value to research participants, investigators, and IRBs. IRB language preferences and requirements, length, and prior experience with alternative consent formats were perceived as barriers. Among patients considering participation in BMT CTN clinical trials, the formatting enhancements of the ETRIC form did not alter comprehension of the trial. Despite local challenges to implementation, trial sites generally viewed the ETRIC form favorably and expressed willingness to use it over standard consent form.
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Affiliation(s)
- Ryan Spellecy
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sergey Tarima
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ellen Denzen
- National Marrow Donor Program, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Heather Moore
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Sunil Abhyankar
- Department of Hematologic Malignancies and Cellular Therapies, Kansas University Medical Center, Kansas City, Kansas
| | | | - Amy Foley
- National Marrow Donor Program, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - Mitchell Horwitz
- Department of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Lensa Idossa
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Steven Joffe
- Division of Medical Ethics, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Roberta King
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Aleksandr Lazaryan
- Department of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Lawrence Morris
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Mary M Horowitz
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
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128
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Banerjee R, Yi JC, Majhail NS, Jim HS, Uberti J, Whalen V, Loren AW, Syrjala KL. Impact of Extremely Long Driving Distance on Distress and Physical Function in Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.188] [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: 12/01/2022]
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129
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Flagg A, Money L, Bielek K, Majhail NS, Kalaycio ME, Dean RM, Gerds AT, Hill BT, Liu H, Hamilton BK, Jagadeesh D, Sobecks RM, Hanna R. Resolution of Secondary Thrombocytopenia with Thrombopoietin Receptor Agonists in Two Allogeneic Hematopoietic Cell Transplant Recipients Treated at a Pediatric Center. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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130
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Patel SS, Rybicki L, Yurch M, Thomas D, Jagadeesh D, Dean RM, Liu H, Flagg A, Gerds AT, Hill BT, Hanna R, Hamilton BK, Pohlman B, Kalaycio ME, Bolwell B, Zhang A, Majhail NS, Askar M, Sobecks RM. Impact of MHC Class I Chain-Related Gene a (MICA) Mismatch on Haploidentical Hematopoietic Cell Transplantation Outcomes. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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131
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Vanness D, Preussler JM, Burns LJ, Denzen EM, Leppke SN, Majhail NS, Mupfudze T, Saber W, Silver A, Steinert P, Mau LW. Estimating Propensity Scores for the Receipt of Allogeneic Hematopoietic Cell Transplantation (AlloHCT) in Outcomes Research Using Claims Data: A Machine Learning Approach. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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132
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Hamilton BK, Liu Y, Hemmer M, Wang T, Chhabra S, Costa LJ, Kim DD, Ringden O, Stuart RK, Alousi AM, Couriel DR, Pidala JA, Spellman SR, Majhail NS, Arora M. Cyclosporine in Combination with Mycophenolate Mofetil Leads to Increased Incidence of Graft-Versus-Host Disease and Inferior Outcomes after Myeloablative Allogeneic Hematopoietic Cell Transplantation: A CIBMTR Analysis. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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133
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Patel SS, Rybicki L, Corrigan D, Jagadeesh D, Dean RM, Liu H, Flagg A, Gerds AT, Hill BT, Hanna R, Bolwell B, Pohlman B, Kalaycio ME, Sobecks RM, Majhail NS, Hamilton BK. Propensity Matched Analysis of Autologous Hematopoietic Stem Cell Transplantation Outcomes in Solid Organ Transplant Recipients. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.255] [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: 11/25/2022]
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134
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Chhabra S, Liu Y, Hemmer M, Wang T, Hamilton BK, Costa LJ, Kim DD, Majhail NS, Stuart RK, Alousi AM, Couriel DR, Pidala JA, Spellman SR, Ringden O, Arora M. Graft-Versus-Host Disease Prophylaxis in Reduced Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation: Comparing the Efficacy of Mycophenolate Mofetil and Methotrexate in Combination with Calcineurin Inhibitor. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.119] [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: 11/26/2022]
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135
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Patel SS, Rybicki L, Yurch M, Thomas D, Jagadeesh D, Dean RM, Liu H, Flagg A, Cober E, Mossad SB, Gerds AT, Hill BT, Hanna R, Hamilton BK, Pohlman B, Kalaycio ME, Bolwell B, Zhang A, Majhail NS, Askar M, Sobecks RM. Impact of MHC Class I Chain-Related Gene a (MICA) Mismatch on Umbilical Cord Blood Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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136
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Ramgopal A, Hanna R, Flagg A, Buhtoiarov I, Majhail NS, Dean RM, Hamilton BK, Gerds AT, Money L, Bielek K. Safety of Allogeneic HCT in Beta Thalassemia Patients with Chronic Hepatitis C Virus Infections Treated at a Pediatric Center. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.479] [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: 11/25/2022]
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137
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El-Asmar J, Rybicki L, Bernhard L, Coffman J, Corrigan D, Dean RM, Gerds AT, Hamilton BK, Hill BT, Jagadeesh D, Kalaycio ME, Liu H, Pohlman B, Serafino S, Urban TA, Sobecks RM, Majhail NS. Complication Rates and Resource Utilization in the First 100 Days Following Allogeneic Hematopoietic Cell Transplantation (Allo HCT) Using Related Haploidentical Donors (Haplo) or Umbilical Cord Blood (UCB). Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.256] [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: 11/16/2022]
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138
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Ferraro CS, Bernhard L, Coffman J, Majhail NS, Hamilton BK. Optimizing Long-Term Care for Hematopoietic Cell Transplantation (HCT) Survivors: Framework for Establishing a New Blood and Marrow Transplant (BMT) Survivorship Program. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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139
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Khera N, Hamilton BK, Wood WA, Wu V, Onstad L, Alousi AM, Broady R, Chen GL, Arora M, Cutler C, Flowers ME, Ganetsky A, Jagasia M, McCarthy PL, Pidala JA, Sarantopoulos S, Abel GA, Majhail NS, Lee SJ. Employment, Insurance and Financial Experiences of Patients with Chronic Graft-Versus-Host Disease. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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140
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Patel SS, Rybicki LA, Corrigan D, Bolwell B, Dean R, Liu H, Gerds AT, Hanna R, Hill B, Jagadeesh D, Kalaycio M, Pohlman B, Sobecks R, Majhail NS, Hamilton BK. Prognostic Factors for Mortality among Day +100 Survivors after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:1029-1034. [PMID: 29369800 DOI: 10.1016/j.bbmt.2018.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 01/15/2018] [Indexed: 11/24/2022]
Abstract
Although day +100 survival among allogeneic hematopoietic cell transplantation (HCT) recipients has improved over time, longer-term survival remains a challenge. The aim of this study was to identify prognostic factors for survival among patients surviving longer than 100 days using baseline characteristics and factors identified within the first 100 days after transplantation. Of 413 patients undergoing a first allogeneic HCT between 2006 and 2014, 335 survived >100 days post-transplantation. The majority underwent a myeloablative transplantation (75%) with a bone marrow (BM) (52%) graft source. One-year all-cause mortality (ACM) was 29%, with 16% relapse mortality (RM) and 12% nonrelapse mortality. In multivariable analysis, high-risk disease (hazard ratio [HR], 1.55; P = .003), non-cytomegalovirus infection (HR, 1.79; P = .003), more days hospitalized (HR, 1.16; P < .001), and relapse (HR, 4.38; P < .001) within the first 100 days were associated with increased risk of ACM. Patients with higher income (HR, .89; P = .024) and those who received BM (HR, .52; P < .001) or umbilical cord blood (HR, .40; P = .002) relative to peripheral blood stem cells had lower risk of ACM. Our study identifies risk factors for adverse long-term survival in 100-day survivors, a time point when patients frequently are discharged from transplantation centers. In addition to disease- and transplantation-related factors, low socioeconomic status was associated with worse long-term survival, highlighting the need for focused efforts to improve outcomes in vulnerable patient populations.
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Affiliation(s)
- Sagar S Patel
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Lisa A Rybicki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Donna Corrigan
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Bolwell
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert Dean
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hien Liu
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aaron T Gerds
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rabi Hanna
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Hill
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Deepa Jagadeesh
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matt Kalaycio
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brad Pohlman
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ronald Sobecks
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Navneet S Majhail
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Betty K Hamilton
- Blood and Marrow Transplantation Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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141
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Abdel-Wahab O, Abrahm JL, Adams S, Adewoye AH, Allen C, Ambinder RF, Anasetti C, Anastasi J, Anderson JA, Antin JH, Antony AC, Araten DJ, Armand P, Armstrong G, Armstrong SA, Arnold DM, Artz AS, Awan FT, Baglin TP, Benson DM, Benz EJ, Berliner N, Bhagat G, Bhardwaj N, Bhatia R, Bhatia S, Bhatt MD, Bhatt VR, Bitan M, Blinderman CD, Bollard CM, Braun BS, Brenner MK, Brittenham GM, Brodsky RA, Brown M, Broxmeyer HE, Brummel-Ziedins K, Brunner AM, Buadi FK, Burkhardt B, Burns M, Byrd JC, Caimi PF, Caligiuri MA, Canavan M, Cantor AB, Carcao M, Carroll MC, Carty SA, Castillo JJ, Chan AK, Chapin J, Chiu A, Chute JP, Clark DB, Coates TD, Cogle CR, Connell NT, Cooke E, Cooley S, Corradini P, Creager MA, Creger RJ, Cromwell C, Crowther MA, Cushing MM, Cutler C, Dang CV, Danial NN, Dave SS, DeCaprio JA, Dinauer MC, Dinner S, Diz-Küçükkaya R, Dodd RY, Donato ML, Dorshkind K, Dotti G, Dror Y, Dunleavy K, Dvorak CC, Ebert BL, Eck MJ, Eikelboom JW, Epperla N, Ershler WB, Evans WE, Faderl S, Ferrara JL, Filipovich AH, Fischer M, Fredenburgh JC, Friedman KD, Fuchs E, Fuller SJ, Gailani D, Galipeau J, Gallagher PG, Ganapathi KA, Gardner LB, Gee AP, Gerson SL, Gertz MA, Giardina PJ, Gibson CJ, Golan K, Golub TR, Gonzales MJ, Gotlib J, Gottschalk S, Grant MA, Graubert TA, Gregg XT, Gribben JG, Gross DM, Gruber TA, Guitart J, Gurbuxani S, Gur-Cohen S, Gutierrez A, Hamadani M, Hari PN, Hartwig JH, Hayman SR, Hayward CP, Hebbel RP, Heslop HE, Hillis C, Hillyer CD, Ho K, Hockenbery DM, Hoffman R, Hogg KE, Holtan SG, Horny HP, Hsu YMS, Hunter ZR, Huntington JA, Iancu-Rubin C, Iqbal A, Isenman DE, Israels SJ, Italiano JE, Jaffe ES, Jaffer IH, Jagannath S, Jäger U, Jain N, James P, Jeha S, Jordan MB, Josephson CD, Jung M, Kager L, Kambayashi T, Kanakry JA, Kantarjian HM, Kaplan J, Karafin MS, Karsan A, Kaufman RJ, Kaufman RM, Keller FG, Kelly KM, Kessler CM, Key NS, Keyzner A, Khandoga AG, Khanna-Gupta A, Khatib-Massalha E, Klein HG, Knoechel B, Kollet O, Konkle BA, Kontoyiannis DP, Koreth J, Koretzky GA, Kotecha D, Kremyanskaya M, Kumari A, Kuzel TM, Küppers R, Lacy MQ, Ladas E, Landier W, Lapid K, Lapidot T, Larson PJ, Levi M, Lewis RE, Liebman HA, Lillicrap D, Lim W, Lin JC, Lindblad R, Lip GY, Little JA, Lohr JG, López JA, Luscinskas FW, Maciejewski JP, Majhail NS, Manches O, Mandle RJ, Mann KG, Manno CS, Marcogliese AN, Mariani G, Marincola FM, Mascarenhas J, Massberg S, McEver RP, McGrath E, McKinney MS, Mehta RS, Mentzer WC, Merlini G, Merryman R, Michel M, Migliaccio AR, Miller JS, Mims MP, Mondoro TH, Moorehead P, Muniz LR, Munshi NC, Najfeld V, Nayak L, Nazy I, Neff AT, Ness PM, Notarangelo LD, O'Brien SH, O'Connor OA, O'Donnell M, Olson A, Orkin SH, Pai M, Pai SY, Paidas M, Panch SR, Pande RL, Papayannopoulou T, Parikh R, Petersdorf EW, Peterson SE, Pittaluga S, Ponce DM, Popolo L, Prchal JT, Pui CH, Puigserver P, Rak J, Ramos CA, Rand JH, Rand ML, Rao DS, Ravandi F, Rawlings DJ, Reddy P, Reding MT, Reiter A, Rice L, Riese MJ, Ritchey AK, Roberts DJ, Roman E, Rooney CM, Rosen ST, Rosenthal DS, Rossmann MP, Rot A, Rowley SD, Rubnitz JE, Rydz N, Salama ME, Sauk S, Saunthararajah Y, Savage W, Scadden D, Schaefer KG, Schiffman F, Schneidewend R, Schrier SL, Schuchman EH, Scullion BF, Selvaggi KJ, Senoo K, Shaheen M, Shaz BH, Shelburne SA, Shpall EJ, Shurin SB, Siegal D, Silberstein LE, Silberstein L, Silverstein RL, Sloan SR, Smith FO, Smith JW, Smith K, Steensma DP, Steinberg MH, Stock W, Storry JR, Stramer SL, Strauss RG, Stroncek DF, Taylor J, Thota S, Treon SP, Tulpule A, Valdes RF, Valent P, Vedantham S, Vercellotti GM, Verneris MR, Vichinsky EP, von Andrian UH, Vose JM, Wagner AJ, Wang E, Wang JH, Warkentin TE, Wasserstein MP, Webster A, Weisdorf DJ, Weitz JI, Westhoff CM, Wheeler AP, Widick P, Wiley JS, William BM, Williams DA, Wilson WH, Wolfe J, Wolgast LR, Wood D, Wu J, Yahalom J, Yee DL, Younes A, Young NS, Zeller MP. Contributors. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Holtan SG, Majhail NS, Weisdorf DJ. Complications After Hematopoietic Cell Transplantation. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00109-8] [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: 12/01/2022] Open
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Hong S, Rybicki LA, Corrigan D, Schold JD, Majhail NS. Community Risk Score for Evaluating Health Care Disparities in Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2017; 24:877-879. [PMID: 29292058 DOI: 10.1016/j.bbmt.2017.12.800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/20/2017] [Indexed: 01/08/2023]
Abstract
There is a critical need for tools to comprehensively describe disparities in hematopoietic cell transplant (HCT) recipients. We conducted a retrospective cohort study to evaluate a Community Risk Score (CRS) tool for this purpose. CRS included 10 community health indicators based on county or state of residence obtained from several secondary data sources and a composite score was assigned to each county (range 0 to 40), that was further categorized into six tiers (I to VI) with higher tiers indicating poor community health. CRS was assessed for 509 allogeneic and 1033 autologous HCT recipients from 2003 to 2013. Our cohort represented allogeneic and autologous HCT recipients from 300 and 431 unique ZIP codes from 99 and 125 counties in 15 and 16 states, although 86% and 90% patients were from Ohio, respectively. A greater proportion of patients had adverse individual community risk indicators in higher-risk tiers (P < .001 for trend for all). In multivariable analysis, clear trends toward association of CRS with outcomes were not observed. For autologous HCTs, Tier III has higher risks of relapse mortality (hazard ratio [HR] 2.2, P = .02) and all-cause mortality (HR 1.8, P = 0.03). In conclusion, CRS was able to categorize patients into groups representing greater levels of health care disparities. We did not see a clear association between CRS and transplant outcomes, although our cohort was limited to a relatively small group of counties. Community-based risk score model may serve as a tool for evaluating disparities in HCT recipients, but its validation in a nationally representative cohort of patients is needed.
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Affiliation(s)
- Sanghee Hong
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington
| | - Lisa A Rybicki
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Donna Corrigan
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
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Molenaar RJ, Sidana S, Radivoyevitch T, Advani AS, Gerds AT, Carraway HE, Angelini D, Kalaycio M, Nazha A, Adelstein DJ, Nasr C, Maciejewski JP, Majhail NS, Sekeres MA, Mukherjee S. Risk of Hematologic Malignancies After Radioiodine Treatment of Well-Differentiated Thyroid Cancer. J Clin Oncol 2017; 36:1831-1839. [PMID: 29252123 DOI: 10.1200/jco.2017.75.0232] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To investigate the risk and outcomes of second hematologic malignancies (SHMs) in a population-based cohort of patients with well-differentiated thyroid cancer (WDTC) treated or not with radioactive iodine (RAI). Methods Patients with WDTC were identified from SEER registries. Competing risk regression analysis was performed to calculate the risks of SHMs that occurred after WDTC treatment and outcomes after SHM development were assessed. Results Of 148,215 patients with WDTC, 53% received surgery alone and 47% received RAI. In total, 783 patients developed an SHM after a median interval of 6.5 years (interquartile range, 3.3 to 11.2 years) from WDTC diagnosis. In multivariable analysis, compared with those undergoing thyroidectomy alone, RAI treatment was associated with an increased early risk of developing acute myeloid leukemia (AML; hazard ratio, 1.79; 95% CI, 1.13 to 2.82; P = .01) and chronic myeloid leukemia (CML; hazard ratio, 3.44; 95% CI, 1.87 to 6.36; P < .001). This increased risk of AML and CML after RAI treatment was seen even in low-risk and intermediate-risk WDTC tumors. Occurrence of AML but not CML in patients with WDTC was associated with shorter median overall survival compared with matched controls (8.0 years v 31.0 years; P = .001). In addition, AML developing after RAI trended toward inferior survival compared with matched controls with de novo AML (median overall survival, 1.2 years v 2.9 years; P = .06). Conclusion Patients with WDTC treated with RAI had an increased early risk of developing AML and CML but no other hematologic malignancies. AML that arises after RAI treatment has a poor prognosis. RAI use in patients with WDTC should be limited to patients with high-risk disease features, and patients with WDTC treated with adjuvant RAI should be monitored for myeloid malignancies as part of cancer surveillance.
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Affiliation(s)
- Remco J Molenaar
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Surbhi Sidana
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Tomas Radivoyevitch
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Anjali S Advani
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Aaron T Gerds
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Hetty E Carraway
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Dana Angelini
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Matt Kalaycio
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Aziz Nazha
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - David J Adelstein
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Christian Nasr
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Jaroslaw P Maciejewski
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Navneet S Majhail
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Mikkael A Sekeres
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
| | - Sudipto Mukherjee
- Remco J. Molenaar, Surbhi Sidana, Tomas Radivoyevitch, Anjali S. Advani, Aaron T. Gerds, Hetty E. Carraway, Dana Angelini, Matt Kalaycio, Aziz Nazha, David J. Adelstein, Christian Nasr, Jaroslaw P. Maciejewski, Navneet S. Majhail, Mikkael A. Sekeres, and Sudipto Mukherjee, Cleveland Clinic, Cleveland, OH; Remco J. Molenaar, University of Amsterdam, Amsterdam, the Netherlands; and Surbhi Sidana, Mayo Clinic, Rochester, MN
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Neumann JL, Mau LW, Virani S, Denzen EM, Boyle DA, Boyle NJ, Dabney J, De KeselLofthus A, Kalbacker M, Khan T, Majhail NS, Murphy EA, Paplham P, Parran L, Perales MA, Rockwood TH, Schmit-Pokorny K, Shanafelt TD, Stenstrup E, Wood WA, Burns LJ. Burnout, Moral Distress, Work-Life Balance, and Career Satisfaction among Hematopoietic Cell Transplantation Professionals. Biol Blood Marrow Transplant 2017; 24:849-860. [PMID: 29196079 DOI: 10.1016/j.bbmt.2017.11.015] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [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: 08/01/2017] [Accepted: 11/13/2017] [Indexed: 11/29/2022]
Abstract
A projected shortage of hematopoietic cell transplantation (HCT) health professionals was identified as a major issue during the National Marrow Donor Program/Be The Match System Capacity Initiative. Work-related distress and work-life balance were noted to be potential barriers to recruitment/retention. This study examined these barriers and their association with career satisfaction across HCT disciplines. A cross-sectional, 90-item, web-based survey was administered to advanced practice providers, nurses, physicians, pharmacists, and social workers in 2015. Participants were recruited from membership lists of 6 professional groups. Burnout (measured with the Maslach Burnout Inventory subscales of emotional exhaustion and depersonalization) and moral distress (measured by Moral Distress Scale-Revised) were examined to identify work-related distress. Additional questions addressed demographics, work-life balance, and career satisfaction. Of 5759 HCT providers who received an individualized invitation to participate, 914 (16%) responded; 627 additional participants responded to an open link survey. Significant differences in demographic and practice characteristics existed across disciplines (P < .05). The prevalence of burnout differed across disciplines (P < .05) with an overall prevalence of 40%. Over one-half of pharmacists had burnout, whereas social workers had the lowest prevalence at less than one-third. Moral distress scores ranged from 0 to 336 and varied by discipline (P < .05); pharmacists had the highest mean score (62.9 ± 34.8) and social workers the lowest (42.7 ± 24.4). In multivariate and univariate analyses, variables contributing to burnout varied by discipline; however, moral distress was a significant contributing factor for all providers. Those with burnout were more likely to report inadequate work-life balance and a low level of career satisfaction; however, overall there was a high level of career satisfaction across disciplines. Burnout, moral distress, and inadequate work-life balance existed at a variable rate in all HCT disciplines, yet career satisfaction was high. These results suggest specific areas to address in the work environment for HCT health professionals, especially the need for relief of moral distress and a greater degree of personal time. As the creation of healthy work environments is increasingly emphasized to improve quality care and decrease costs, these findings should be used by HCT leadership to develop interventions that mitigate work-related distress and in turn foster recruitment and retention of HCT providers.
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Affiliation(s)
- Joyce L Neumann
- Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Lih-Wen Mau
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Sanya Virani
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Ellen M Denzen
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Deborah A Boyle
- Department of Nursing, University of California Irvine Health/Chao Family Comprehensive Cancer Center, Orange, California
| | - Nancy J Boyle
- Knight Cancer Institute, Center for Hematologic Malignancy, Oregon Health & Science University, Portland, Oregon
| | - Jane Dabney
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | | | - Marion Kalbacker
- Pediatric BMT, Duke University Medical Center, Durham, North Carolina
| | - Tippu Khan
- Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, North Carolina
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | | | - Pamela Paplham
- Roswell Park Cancer Institute Nursing Administration, Buffalo, New York
| | - Leslie Parran
- Department of Nursing, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Todd H Rockwood
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | | | | | - Elaine Stenstrup
- Department of Nursing, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - William A Wood
- Division of Hematology/Oncology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
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147
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Myers RM, Hill BT, Shaw BE, Kim S, Millard HR, Battiwalla M, Majhail NS, Buchbinder D, Lazarus HM, Savani BN, Flowers MED, D'Souza A, Ehrhardt MJ, Langston A, Yared JA, Hayashi RJ, Daly A, Olsson RF, Inamoto Y, Malone AK, DeFilipp Z, Margossian SP, Warwick AB, Jaglowski S, Beitinjaneh A, Fung H, Kasow KA, Marks DI, Reynolds J, Stockerl-Goldstein K, Wirk B, Wood WA, Hamadani M, Satwani P. Long-term outcomes among 2-year survivors of autologous hematopoietic cell transplantation for Hodgkin and diffuse large b-cell lymphoma. Cancer 2017; 124:816-825. [PMID: 29125192 DOI: 10.1002/cncr.31114] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 08/30/2017] [Revised: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Autologous hematopoietic cell transplantation (auto-HCT) is a standard therapy for relapsed classic Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL); however, long-term outcomes are not well described. METHODS This study analyzed survival, nonrelapse mortality, late effects, and subsequent malignant neoplasms (SMNs) in 1617 patients who survived progression-free for ≥2 years after auto-HCT for cHL or DLBCL between 1990 and 2008. The median age at auto-HCT was 40 years; the median follow-up was 10.6 years. RESULTS The 5-year overall survival rate was 90% (95% confidence interval [CI], 87%-92%) for patients with cHL and 89% (95% CI, 87%-91%) for patients with DLBCL. The risk of late mortality in comparison with the general population was 9.6-fold higher for patients with cHL (standardized mortality ratio [SMR], 9.6) and 3.4-fold higher for patients with DLBCL (SMR, 3.4). Relapse accounted for 44% of late deaths. At least 1 late effect was reported for 9% of the patients. A total of 105 SMNs were confirmed: 44 in the cHL group and 61 in the DLBCL group. According to a multivariate analysis, older age, male sex, a Karnofsky score < 90, total body irradiation (TBI) exposure, and a higher number of lines of chemotherapy before auto-HCT were risk factors for overall mortality in cHL. Risk factors in DLBCL were older age and TBI exposure. A subanalysis of 798 adolescent and young adult patients mirrored the outcomes of the overall study population. CONCLUSIONS Despite generally favorable outcomes, 2-year survivors of auto-HCT for cHL or DLBCL have an excess late-mortality risk in comparison with the general population and experience an assortment of late complications. Cancer 2018;124:816-25. © 2017 American Cancer Society.
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Affiliation(s)
- Regina M Myers
- Divisions of Hematology and Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Pennsylvania
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Soyoung Kim
- 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
| | - Heather R Millard
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Minoo Battiwalla
- Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, California
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Amelia Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Jean A Yared
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Adriana K Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven P Margossian
- Department of Pediatric Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anne B Warwick
- Department of Pediatrics, Uniformed Services Industry of the Health Sciences, Bethesda, Maryland
| | - Samantha Jaglowski
- Division of Hematology, Ohio State University Medical Center, Columbus, Ohio
| | | | - Henry Fung
- Department of Medical Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | - Kimberly A Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | | | | | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Prakash Satwani
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York
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148
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Abuhadra N, Majhail NS, Nazha A. Impact of social media for the hematologist/oncologist. Semin Hematol 2017; 54:193-197. [DOI: 10.1053/j.seminhematol.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/11/2022]
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149
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Pemmaraju N, Mesa RA, Majhail NS, Thompson MA. The use and impact of Twitter at medical conferences: Best practices and Twitter etiquette. Semin Hematol 2017; 54:184-188. [PMID: 29153078 PMCID: PMC8148883 DOI: 10.1053/j.seminhematol.2017.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 12/15/2022]
Abstract
The use of social media, and in particular, Twitter, for professional use among healthcare providers is rapidly increasing across the world. One medical subspecialty that is leading the integration of this new platform for communication into daily practice and for information dissemination to the general public is the field of hematology/oncology. A growing amount of research in this area demonstrates that there is increasing interest among physicians to learn not only how to use social media for consumption of educational material, but also how to generate and contribute original content in one's interest/expert areas. One aspect in which this phenomenon has been highlighted is at the time of maximum new information presentation: at a major medical conference. Hematologists/oncologists are engaging regularly in one of the most common forms of social media, Twitter, during major medical conferences, for purposes of debate, discussion, and real-time evaluation of the data being presented. As interest has grown in this area, this article aims to review the new norms, practices, and impact of using Twitter at the time of medical conferences, and also explores some of the barriers and pitfalls that users are encountering in this emerging field.
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Affiliation(s)
| | - Ruben A Mesa
- University of Texas San Antonio, San Antonio, TX
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150
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Gajewski JL, McClellan MB, Majhail NS, Hari PN, Bredeson CN, Maziarz RT, LeMaistre CF, Lill MC, Farnia SH, Komanduri KV, Boo MJ. Payment and Care for Hematopoietic Cell Transplantation Patients: Toward a Specialized Medical Home for Complex Care Patients. Biol Blood Marrow Transplant 2017; 24:4-12. [PMID: 28963077 DOI: 10.1016/j.bbmt.2017.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/20/2017] [Indexed: 12/15/2022]
Abstract
Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time. Payment is linked to quality measures, including proportion of care delivered according to predefined pathways and demonstrated impact on outcomes. Some medical homes also include opportunities for shared savings by reducing overall costs of care. Recent proposals have suggested expanding the medical home model to specialized populations with complex needs because primary care teams may not have the facilities or the requisite expertise for their unique needs. An example of a successful care model that may provide valuable lessons for those creating specialty medical home models already exists in many hematopoietic cell transplantation (HCT) centers that deliver multidisciplinary, coordinated, and highly specialized care. The integration of care delivery in HCT centers has been driven by the specialty care their patients require and by the payment methodology preferred by the commercial payers, which has included bundling of both inpatient and outpatient care in the peritransplant interval. Commercial payers identify qualified HCT centers based on accreditation status and comparative performance, enabled in part by center-level comparative performance data available within a national outcomes database mandated by the Stem Cell Therapeutic and Research Act of 2005. Standardization across centers has been facilitated via voluntary accreditation implemented by Foundation for the Accreditation of Cell Therapy. Payers have built on these community-established programs and use public outcomes and program accreditation as standards necessary for inclusion in specialty care networks and contracts. Although HCT centers have not been described as medical homes, most HCT providers have already developed the structures that address critical requirements of MACRA for medical homes.
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Affiliation(s)
- James L Gajewski
- Department of Health Policy and Strategic Relations, American Society for Blood and Marrow Transplantation, Chicago, Illinois.
| | - Mark B McClellan
- Duke University Margolis Center for Health Policy, Durham, North Carolina
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Division of Hematology & Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Richard T Maziarz
- Stem Cell Transplantation Program, Division of Hematology & Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Michael C Lill
- Stem Cell and Bone Marrow Transplant Program, Division of Hematology and Medical Oncology, Samuel Oschin Comprehensive Cancer Center, Los Angeles, California
| | - Stephanie H Farnia
- Department of Health Policy and Strategic Relations, American Society for Blood and Marrow Transplantation, Chicago, Illinois
| | - Krishna V Komanduri
- Adult Hematopoietic Stem Cell Transplant Program, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Michael J Boo
- National Marrow Donor Program, Minneapolis, Minnesota
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