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Singh AK, Porrata LF, Aljitawi O, Lin T, Shune L, Ganguly S, McGuirk JP, Abhyankar S. Fatal GvHD induced by PD-1 inhibitor pembrolizumab in a patient with Hodgkin's lymphoma. Bone Marrow Transplant 2016; 51:1268-70. [PMID: 27111048 DOI: 10.1038/bmt.2016.111] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Rinehart M, Hochard E, Rockey M, Abhyankar S, Ganguly S, Lin T, McGuirk J, Shune L, Singh A, Aljitawi O. Evaluation of cytomegalovirus reactivation and tolerability in seropositive umbilical cord transplant patients after implementation of an intensive prevention strategy. Hematol Oncol Stem Cell Ther 2016; 9:105-11. [PMID: 27013276 DOI: 10.1016/j.hemonc.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 01/29/2016] [Accepted: 02/17/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE/BACKGROUND Cytomegalovirus (CMV) causes significant morbidity and mortality in CMV seropositive patients undergoing umbilical cord blood transplants (UCBT). Our study aimed to describe the incidence of CMV reactivation and burden of disease, as well as the tolerability of an intensive prevention strategy as compared to historical prevention. METHODS This was a retrospective chart review of 33 CMV seropositive patients that underwent UCBT. The intensive prevention strategy in UCBT consisted of ganciclovir 5mg/kg/d intravenously or valganciclovir 900mg by mouth daily initiated at the beginning of the conditioning regimen until Day -2. Then from Day -1 to Day +100, patients received valacyclovir 2g by mouth three times daily, and from Day +101 to Day +365, acyclovir 800mg by mouth twice daily. Historical standard prevention was acyclovir 800mg by mouth twice daily initiated at the beginning of the conditioning regimen until Day +365. RESULTS Thirty-three patients were included from 2008 to 2014. There were no differences in the adverse effects experienced between the two regimens (p=.4). CMV reactivation occurred significantly later with intensive prevention (p=.003). The median CMV viral titer at reactivation was lower in the intensive versus the historic prevention (1,800copies/mL and 2,700copies/mL, respectively), but was not significantly different. CMV disease occurred significantly less often in the intensive group (p=.039). CONCLUSION The results from this study indicate that the intensive prevention strategy was well tolerated, significantly delayed CMV reactivation, and patients had less CMV disease.
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Abhyankar S, Lubanski P, DeJarnette S, Merkel D, Bunch J, Daniels K, Aljitawi O, Lin T, Ganguly S, McGuirk J. A novel hematopoietic progenitor cell mobilization regimen, utilizing bortezomib and filgrastim, for patients undergoing autologous transplant. J Clin Apher 2016; 31:559-563. [PMID: 26939585 DOI: 10.1002/jca.21449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/08/2016] [Accepted: 01/16/2016] [Indexed: 12/20/2022]
Abstract
Adequate hematopoietic progenitor cell (HPC) collection is critical for patients undergoing autologous HPC transplant (AHPCT). Historically, 15 - 30% of patients failed HPC mobilization with granulocyte-colony stimulating factor (G-CSF) alone. Bortezomib, a proteasome inhibitor, has been shown to down regulate very late antigen-4 (VLA-4), an adhesion molecule expressed on HPCs. In this pilot study, bortezomib was administered on days -11 and -8 at a dose of 1.3 mg/m2 intravenously (IV) or subcutaneously (SQ), followed by G-CSF 10 mcg/kg SQ, on days -4 to -1 prior to HPC collection (Day 1). Nineteen patients, with multiple myeloma (n = 12) or non-Hodgkin lymphoma (n = 7) undergoing AHPCT for the first time, were enrolled. Patients were excluded if they had worse than grade II neuropathy or platelet count less than 100 x 109 /L. Bortezomib was well tolerated and all patients had adequate HPC collections with no mobilization failures. One patient (6%) had a CD34+ cell count of 3.9 cells/µL on Day 1 and received plerixafor per institutional algorithm. Eleven patients completed HPC collection in 1 day and eight in 2 days. All patients underwent AHPCT and had timely neutrophil and platelet engraftment. Comparison with a historical control group of 70 MM and lymphoma patients, who were mobilized with G-CSF, showed significantly higher CD 34+ cells/kg collected in the bortezomib mobilization study group. Bortezomib plus G-CSF is an effective HPC mobilizing regimen worth investigating further in subsequent studies. J. Clin. Apheresis 31:559-563, 2016. © 2015 Wiley Periodicals, Inc.
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Carpenter PA, Logan BR, Lee SJ, Weisdorf DJ, Johnston L, Costa LJ, Kitko CL, Bolaños-Meade J, Alousi AM, Horowitz MM, Abhyankar S, Waller EK, Mendizabal A, Wang Y, Lazaryan A, Carter SL, Nemecek ER, Pavletic SZ, Cutler CS, Arora M. Prednisone (PDN)/Sirolimus (SRL) Compared to PDN/SRL/Calcineurin Inhibitor (CNI) as Treatment for Chronic Graft-Versus-Host-Disease (cGVHD): A Randomized Phase II Study from the Blood and Marrow Transplant Clinical Trials Network. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim CS, Choi Y, Lee S, Lee H, Ueda T, Yonese J, Fukagai T, Chiong E, Lau W, Abhyankar S, Theeuwes A, Tombal B, Beer T, Kimura G. 242PD Subgroup analysis of Asian men in the PREVAIL trial of enzalutamide (ENZA) in men with chemotherapy-naïve, metastatic castration-resistant prostate cancer (mCRPC). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv524.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bray WM, Bivona C, Rockey M, Henry D, Grauer D, Abhyankar S, Aljitawi O, Ganguly S, McGuirk J, Singh A, Lin TL. Outcomes for newly diagnosed patients with acute myeloid leukemia dosed on actual or adjusted body weight. Cancer Chemother Pharmacol 2015; 76:691-7. [PMID: 26231954 PMCID: PMC4725583 DOI: 10.1007/s00280-015-2829-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/13/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Data from solid tumor malignancies suggest that actual body weight (ABW) dosing improves overall outcomes. There is the potential to compromise efficacy when chemotherapy dosages are reduced, but the impact of dose adjustment on clinical response and toxicity in hematologic malignancies is unknown. The purpose of this study was to evaluate the outcomes of utilizing a percent of ABW for acute myeloid leukemia (AML) induction chemotherapy dosing. METHODS This retrospective, single-center study included 146 patients who received 7 + 3 induction (cytarabine and anthracycline) for treatment of AML. Study design evaluated the relationship between percentage of ABW dosing and complete response (CR) rates in patients newly diagnosed with AML. RESULTS Percentage of ABW dosing did not influence CR rates in patients undergoing induction chemotherapy for AML (p = 0.83); nor did it influence rate of death at 30 days or relapse at 6 months (p = 0.94). When comparing patients dosed at 90-100 % of ABW compared to <90 % ABW, CR rates were not significantly different in patients classified as poor risk (p = 0.907). All favorable risk category patients obtained CR. CONCLUSIONS Preemptive dose reductions for obesity did not influence CR rates for patients with AML undergoing induction chemotherapy and did not influence the composite endpoint of death at 30 days or disease relapse at 6 months.
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Brownback KR, Simpson SQ, Pitts LR, Polineni D, McGuirk JP, Ganguly S, Aljitawi OS, Lin TL, Singh A, Abhyankar S. Effect of extracorporeal photopheresis on lung function decline for severe bronchiolitis obliterans syndrome following allogeneic stem cell transplantation. J Clin Apher 2015; 31:347-52. [DOI: 10.1002/jca.21404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/01/2015] [Accepted: 04/29/2015] [Indexed: 12/18/2022]
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Lin TL, Williams T, He J, Aljitawi OS, Ganguly S, Abhyankar S, Fleming A, Male H, McGuirk JP. Rates of complete diagnostic testing for patients with acute myeloid leukemia. Cancer Med 2015; 4:519-22. [PMID: 25620650 PMCID: PMC4402066 DOI: 10.1002/cam4.406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/05/2014] [Accepted: 12/05/2014] [Indexed: 12/17/2022] Open
Abstract
In addition to cytogenetics, additional molecular markers of prognosis have been identified and incorporated into the management of patients with acute myeloid leukemia (AML). We hypothesized that rates of molecular testing would be higher in an academic center versus community sites. A retrospective chart review included all de novo AML patients (excluding M3) at Kansas University Medical Center (KUMC) from January 2008 through April 2013. Records were evaluated for completeness of molecular testing as indicated by karyotype (FLT3, CEBPα, NPM1 in normal cytogenetics AML and c-KIT in core binding factor [CBF] AML). 271 charts were reviewed: 98 with CN-AML and 29 with CBF AML. Seventy were diagnosed at KUMC, 57 at a community site. Molecular testing was sent in 76/98 (77%) patients with CN-AML. Patients diagnosed at KUMC had a significantly higher rate of molecular testing (51/55, 93%) as compared to those diagnosed at outside centers (18/43, 41%) (P < 0.001). Of 29 patients with CBF AML, c-kit mutational analysis was performed more frequently at KUMC (14/15, 93%) than in community sites (8/14, 57%) (P = 0.035). There was a trend towards increased testing at both KUMC and community sites in later years. Rates of molecular testing in AML were higher in an academic center versus community sites in the 5 years following the World Health Organization revised classification of AML. All physicians who diagnose and treat AML must remain up to date on the latest recommendations and controversies in molecular testing in order to appropriately risk stratify patients and determine optimal therapy.
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Aljitawi O, Ganguly S, Lin TL, Mahnken J, Palla SL, Bunch J, Supancic S, Singh AK, Shune L, Abhyankar S, Allin D, McGuirk J. First Report on an Ongoing Pilot Clinical Study Incorporating Hyperbaric Oxygen into Autologous Peripheral Blood Stem Cell Transplantation. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Luu Tran H, Mahmoudjafari Z, Rockey M, Henry D, Grauer D, Aljitawi O, Abhyankar S, Ganguly S, Lin T, McGuirk J. Tolerability and outcome of once weekly liposomal amphotericin B for the prevention of invasive fungal infections in hematopoietic stem cell transplant patients with graft-versus-host disease. J Oncol Pharm Pract 2014; 22:228-34. [PMID: 25471252 DOI: 10.1177/1078155214560920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Invasive fungal infections remain problematic in immunosuppressed allogeneic stem cell transplant recipients and the use of corticosteroids for the treatment of graft-versus-host-disease can increase the risk threefold. Although antifungal prophylaxis has been shown to decrease the incidence of infection, the optimal antifungal prophylactic regimen in this patient population has yet to be identified.Since early diagnosis of fungal infections might not be possible and the treatment of established fungal infections might be difficult and associated with high infection-related mortality, prevention has become an important strategy in reducing overall morbidity and mortality. While triazoles are the preferred agents, some patients are unable to tolerate them and an alternative drug is warranted. OBJECTIVES To assess the tolerability of once weekly liposomal amphotericin B as a prophylactic strategy in patients undergoing stem cell transplantation by evaluating any adverse events leading to its discontinuation. In terms of efficacy, to also compare the outcome and incidence of invasive fungal infections in patients who received amphotericin B, triazoles, and echinocandins. RESULTS A total of 101 allogeneic transplant recipients receiving corticosteroids for the treatment of graft-versus-host-disease and antifungal prophylaxis were evaluated from August 2009 to September 2012. Liposomal amphotericin B 3 mg/kg intravenous once weekly was found to be well tolerated. The incidence of invasive fungal infections was 19%, 17%, and 7% in the liposomal amphotericin B, echinocandin, and triazole groups, respectively. Two deaths occurred in the liposomal amphotericin B group and one death occurred in the echinocandin group. None of the deaths were fungal infection related. CONCLUSION Antifungal prophylaxis with liposomal amphotericin B was well tolerated, but the incidence of invasive fungal infections in patients receiving liposomal amphotericin B was higher than other antifungal agents in this study. The optimal dose and schedule of liposomal amphotericin B for antifungal prophylaxis in this patient population are still not known and considering its broad spectrum activity, prospective trials in comparison to triazoles are warranted.
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Ganguly S, McRae J, He J, Divine C, Abhyankar S, Aljitawi O, McGuirk JP. Routine radiographic screening after completion of initial chemotherapy and relapse-free survival after transplant in patients with relapsed lymphoma. Leuk Lymphoma 2014; 56:518-9. [PMID: 24828868 DOI: 10.3109/10428194.2014.921916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ganguly S, McRae J, He J, Divine CL, Abhyankar S, Aljitawi O, McGuirk J. Routine Radiographic Screening for Lymphoma before Autologous Stem Cell Transplantation (auto-SCT) Does Not Improve Relapse-Free Survival after Auto-SCT. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dalal J, Yankee T, Hassaballa A, Parker B, Hirner A, Bunch J, McGuirk J, Abhyankar S. Using Lymphocyte Phenotypes to Predict Successful Responses to Extracorporal Photopheresis (ECP) in Patients Suffering from Chronic GvHD. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abhyankar S, Yankee T, Warhadpande D, Hirner A, Bunch J, Merkel D, Ganguly S, Aljitawi O, McGuirk JP. The Addition of Extracorporeal Photophoresis (ECP) to Tacrolimus and Methotrexate to Prevent Acute and Chronic Graft-Versus Host Disease (aGvHD, cGvHD) in Patients Undergoing a Myeloablative (MA) Hematopoietic Cell Transplant (HCT). Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brownback KR, Simpson SQ, McGuirk JP, Lin TL, Abhyankar S, Ganguly S, Aljitawi OS. Pulmonary manifestations of the pre-engraftment syndrome after umbilical cord blood transplantation. Ann Hematol 2013; 93:847-54. [PMID: 24346710 DOI: 10.1007/s00277-013-1981-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
Pre-engraftment syndrome (PES) is a condition occurring after umbilical cord blood transplantation (UCBT) characterized by fever and erythematous skin rash prior to neutrophil engraftment. We sought to determine the incidence and characterize the pulmonary manifestations of PES. A retrospective review of patients who underwent UCBT at the University of Kansas Medical Center over a 5-year period was performed. Data collected included patient baseline characteristics, presence of PES, pulmonary findings, treatments, and survival. Forty-four patients underwent UCBT with 22 of those patients developing PES. Full-intensity myeloablative conditioning regimen was found to be a risk factor for development of PES. Of those 22 patients, 13 had resting hypoxemia. The most common radiographic findings included diffuse ground glass opacities with pleural effusions. Fifteen patients with PES received corticosteroids, of which 12 had improvement in fevers and rash. These patients had a trend toward worse mortality than those not receiving corticosteroids. There was a nonsignificant trend toward worse survival in patients with PES and hypoxemia compared to those without hypoxemia. PES is a common complication following cord blood transplantation, with hypoxemia being present in over half of patients with PES. Hypoxemia with PES and treatment with corticosteroids may portend a worse prognosis.
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Deauna-Limayo D, Aljitawi OS, Ganguly S, Abhyankar S, Wick JA, McGuirk JP. Combined use of multiday palonosetron with aprepitant and low-dose dexamethasone in prevention of nausea and emesis among patients with multiple myeloma and lymphoma undergoing autologous hematopoietic stem cell transplant: A pilot study. J Oncol Pharm Pract 2013; 20:263-9. [PMID: 24005093 DOI: 10.1177/1078155213502103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The current standard for prevention of chemotherapy-induced nausea/vomiting in autologous stem cell transplant only achieves 4-20% emetic control. OBJECTIVES To assess emetic responses to multiday palonosetron, aprepitant, and low-dose dexamethasone among patients with myeloma and lymphoma undergoing autologous hematopoietic stem cell transplant. METHODS Oral aprepitant 125/80/80 mg was administered with intravenous dexamethasone 4 mg and palonosetron 0.25 mg on days -3, -2, -1 for multiple myeloma and days -7 through -3 for lymphoma. Palonosetron was repeated day +3 in both groups. RESULTS A total of 20 patients were enrolled and 18 analyzed. None experienced emetic failure with complete control achieved in 78, 33, and 17% in the acute, delayed, and extended phases, respectively. Nausea occurred in 78% although not significant in 61%, with median Nausea Visual Score of 4.5. Quality of life correlated with emetic and nausea control. Eight patients developed grade 2-3 nonhematologic toxicities with only one event attributed to the study medications. CONCLUSIONS This triplet regimen was feasible with acceptable safety profile in the autologous hematopoietic stem cell transplant setting. Emetic control was best achieved in the acute phase. Lesser degree of emetic and nausea control in the delayed and extended phases impacted quality of life. Our results warrant further evaluation in a larger autologous hematopoietic stem cell transplant population.
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Williams CB, Kambhampati S, Fiskus W, Wick J, Dutreix C, Ganguly S, Aljitawi O, Reyes R, Fleming A, Abhyankar S, Bhalla KN, McGuirk JP. Preclinical and phase I results of decitabine in combination with midostaurin (PKC412) for newly diagnosed elderly or relapsed/refractory adult patients with acute myeloid leukemia. Pharmacotherapy 2013; 33:1341-52. [PMID: 23798029 DOI: 10.1002/phar.1316] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the preclinical activity, clinical maximum tolerated dose (MTD), and recommended phase II dose of midostaurin (MS) combined either sequentially or concurrently with intravenous decitabine (DAC) in newly diagnosed patients 60 years or older or relapsed/refractory adult patients (18 years or older) with acute myeloid leukemia (AML). PATIENTS AND METHODS Cultured and primary AML cells were treated with DAC and/or MS and analyzed by flow cytometry and immunoblot analyses. In the phase I study, 16 patients were enrolled; 8 were newly diagnosed patients 60 years or older and 8 were 18 years or older with relapsed AML. Only 2 of 16 patients (13%) had FLT3-internal tandem duplication (ITD) mutations, and no patient had KIT mutations. RESULTS Compared with treatment with either agent alone, sequential treatment with DAC and MS exerted superior anti-AML activity in cultured and primary FLT3-ITD-expressing AML cells. In the subsequent phase I study, the MTD and schedule of administration of the combination was identified as DAC followed by MS. Three patients developed dose-limiting toxicities: two patients developed pulmonary edema requiring mechanical ventilation and one patient developed a prolonged QTc greater than 500 msec. Based on an intent-to-treat analysis, 57% of the patients achieved stable disease or better while enrolled in the trial; 25% had a complete hematologic response. Pharmacokinetic analysis revealed results similar to those previously reported for MS. CONCLUSION The in vitro combination of DAC and MS is synergistically active against FLT3-ITD mutations expressing AML cells. In a clinical setting, the combination of sequentially administered DAC followed by MS is possible without significant unexpected toxicity, but the concurrent administration of DAC and MS led to pulmonary toxicity after only a few doses. On the basis of these results, additional studies exploring the sequential combination of untreated AML in elderly patients are warranted to further evaluate this combination at the MTD.
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Shaughnessy P, Chao N, Shapiro J, Walters K, McCarty J, Abhyankar S, Shayani S, Helmons P, Leather H, Pazzalia A, Pickard S. Pharmacoeconomics of hematopoietic stem cell mobilization: an overview of current evidence and gaps in the literature. Biol Blood Marrow Transplant 2013; 19:1301-9. [PMID: 23685251 DOI: 10.1016/j.bbmt.2013.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 05/08/2013] [Indexed: 12/22/2022]
Abstract
Adequate hematopoietic stem cell (HSC) mobilization and collection is required prior to proceeding with high dose chemotherapy and autologous hematopoietic stem cell transplant. Cytokines such as G-CSF, GM-CSF, and peg-filgrastim, alone or in combination with plerixafor, and after chemotherapy have been used to mobilize HSCs. Studies have shown that the efficiency of HSC mobilization and collection may vary when different methods of mobilization are used. No studies have shown that survival is significantly affected by the method of mobilization, but some studies have suggested that cost and resource utilization may be different between different mobilization techniques. After the FDA approval of plerixafor with G-CSF to mobilize HSCs many transplant centers became concerned about the cost of HSC mobilization. A panel of experts was convened ant this paper reviews the current literature on the pharmacoeconomics of HSC mobilization.
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Fiskus W, Verstovsek S, Manshouri T, Smith JE, Peth K, Abhyankar S, McGuirk J, Bhalla KN. Dual PI3K/AKT/mTOR inhibitor BEZ235 synergistically enhances the activity of JAK2 inhibitor against cultured and primary human myeloproliferative neoplasm cells. Mol Cancer Ther 2013; 12:577-88. [PMID: 23445613 DOI: 10.1158/1535-7163.mct-12-0862] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hemopoietic progenitor cells (HPC) from myeloproliferative neoplasms (MPN) such as myelofibrosis commonly express mutant JAK2-V617F or other mutations that are associated with increased activities of JAK-STAT5/3, RAS/RAF/MAPK, and PI3K/AKT/mTOR pathways. This confers proliferative and survival advantage on the MPN HPCs. Treatment with JAK tyrosine kinase inhibitor (TKI), for example, TG101209, TG101348 (SAR302503), or INCB018424 (ruxolitinib), inhibits mutant JAK2-mediated signaling. Although effective in reducing constitutional symptoms and splenomegaly, treatment with JAK-TKI does not ameliorate myelofibrosis or significantly improve survival of patients with advanced myelofibrosis. Here, we show that treatment with the dual phosphoinositide-3-kinase (PI3K)/AKT and mTOR inhibitor BEZ235 attenuated PI3K/AKT and mTOR signaling, as well as induced cell-cycle growth arrest and apoptosis of the cultured human JAK2-V617F-expressing HEL92.1.7 (HEL), UKE1 cells, and primary CD34+ myelofibrosis (MF)-MPN cells. Treatment with BEZ235 also induced significant apoptosis of the JAK2-TKI resistant HEL/TGR cells that were selected for resistance against JAK-TKI. Cotreatment with BEZ235 and JAK2-TKI (TG101209 and SAR302503) synergistically induced lethal activity against the cultured and primary CD34+ MPN cells while relatively sparing the normal CD34+ HPCs. These findings create a compelling rationale to determine the in vivo activity of dual PI3K/mTOR inhibitors in combination with JAK inhibitors against myelofibrosis HPCs.
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Fiskus W, Balusu R, Peth K, Hembruff S, Abhyankar S, McGuirk J, Bhalla KN. Abstract 2034: Co-treatment with NPM1 antagonist and FLT3 inhibitor or pan-histone deacetylase inhibitor exerts superior efficacy against cultured and primary human AML cells co-expressing mutant NPM1 and FLT3-ITD. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-2034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In approximately 50% of the normal-karyotype (NK) AML, a mutant (mt) NPM1 is localized in the cytoplasm (NPM1c+), which is pathogenetic for AML. Co-expression of FLT3-ITD with mtNPM1 results in poor outcome in AML. We have previously reported that in the cultured (OCI-AML3) cells carrying mtNPM1, shRNA-mediated knockdown of both the wild-type and mtNPM1 induced p53, p21, p27 and CEBPα, while attenuating the levels of HOXA9 and Meis1. This was associated with the morphologic features of myeloid differentiation, apoptosis, as well as a marked inhibition of the colony growth of OCI-AML3 cells (p<0.01). Additionally, knockdown of NPM1 sensitized OCI-AML3 cells to all-trans retinoic acid (ATRA) (0.25 to 2.0 μM)-induced differentiation and apoptosis (p<0.01). Findings of our present studies demonstrate that, as compared to the shRNA-mediated knockdown of total NPM1 (wild-type and mtNPM1), selective knockdown of mtNPM1 alone induced less differentiation and apoptosis of OCI-AML3 cells, as well as caused less inhibition of the leukemogenic potential of OCI-AML3 cells in NOD/SCID mice. The small molecule inhibitor NSC348884 is known to disrupt the oligomerization of wild-type and mtNPM1. NSC348884 dose-dependently (1.0 to 3.0 μM) induced apoptosis and sensitized OCI-AML3 and primary AML cells expressing NPM1c+ to ATRA-induced apoptosis (p<0.01). Patient-derived primary AML cells co-expressing mtNPM1 and FLT3-ITD, as well as OCI-AML3 cells transfected with FLT3-ITD lentivirus (OCI-AML3/FI cells) that co-expressed NPM1c+ and FLT3-ITD were relatively resistant to NSC348884 and/or ATRA. Notably, combination with NSC348884 (2.0-5.0 μM) and the FLT3 antagonists ponatinib (0.5 to 1.0 μM), AC220 (0.2 to 1.0 μM) or midostaurin (100 to 500 nM) induced more apoptosis than either agent alone against OCI-AML3/FI and primary AML cells co-expressing mtNPM1 and FLT3-ITD (p<0.01). Importantly, treatment with the clinically achievable levels of pan-histone deacetylase inhibitor panobinostat (PS, 10 to 50 nM) depleted NPM1 levels and induced differentiation of OCI-AML3, OCI-AML3/FI, and primary AML cells co-expressing mtNPM1 and FLT3-ITD (40 to 70%). Additionally, as compared to treatment with each agent alone, co-treatment with NSC348884 and PS induced significantly more apoptosis in these cells (p<0.01). This was associated with reduction in the levels of p-FLT3, p-AKT, p-STAT5 and NPM1, as well as induction of p53 and p21 levels. Therefore, co-treatment with an NPM1 antagonist and PS or FLT3 inhibitor is highly active against AML cells co-expressing mtNPM1 and FLT3-ITD. These findings support the rationale for in vivo testing of these combination therapies against AML with co-expression of mtNPM1 and FLT3-ITD.
Citation Format: Warren Fiskus, Ramesh Balusu, Karissa Peth, Stacey Hembruff, Sunil Abhyankar, Joseph McGuirk, Kapil N. Bhalla. Co-treatment with NPM1 antagonist and FLT3 inhibitor or pan-histone deacetylase inhibitor exerts superior efficacy against cultured and primary human AML cells co-expressing mutant NPM1 and FLT3-ITD. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2034. doi:10.1158/1538-7445.AM2013-2034
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Dalal J, Yankee T, Hassballah A, Hirner A, Ryan R, Ganguly S, McGuirk JP, Abhyankar S. An Immunological Assessment of Cytokine Profile of CD4+ Cells in Patients with Chronic Graft vs Host Disease (cGVHD) Undergoing Extracorporal Photopheresis (ECP). Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abhyankar S, DeJarnette S, Bunch J, Merkel D, Ganguly S, Aljitawi O, Harvey E, Daniels K, McGuirk J. A Novel Hematopoietic Progenitor Cell (HPC) Mobilization Regimen, Utilizing Bortezomib and Filgrastim (G-CSF), for Patients Undergoing Autologous HPC Transplant (AHPCT) for Multiple Myeloma (MM) and Non-Hodgkin's Lymphoma (NHL). Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rodriguez L, Zhang D, Ganguly S, Lin T, Abhyankar S, McGuirk J, Aljitawi O. Delayed Neutrophil Engraftment Associated with Early CD 8 Polyclonal Lymphocyte Recovery Post Autologous Stem Cell Transplant for Multiple Myeloma. Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ganguly S, Amin M, Divine C, Aljitawi OS, Abhyankar S, McGuirk JP. Decitabine in patients with relapsed acute myeloid leukemia (AML) after allogeneic stem cell transplantation (allo-SCT). Ann Hematol 2012; 92:549-50. [PMID: 23111661 DOI: 10.1007/s00277-012-1607-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
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Aljitawi OS, Coats A, Zhang D, Ganguly S, Abhyankar S, Lin T, McGuirk JP. Umbilical cord graft-versus-leukemia effect induces remission without the price of graft-versus-host disease: the possible role of NK cells. Clin Transplant 2012; 26:663-4. [PMID: 22938188 DOI: 10.1111/ctr.12006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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