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Emanuel NA, Price S, Hansen DK, Whiting J, Kim J, Gaskill E. Impact of weight and creatinine adjustments on the accuracy of Cockcroft-gault equation in hematopoietic cell transplant patients. Clin Transplant 2023; 37:e15059. [PMID: 37395991 DOI: 10.1111/ctr.15059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Hematopoietic cell transplant (HCT) patients undergo pre- transplant renal function evaluation to confirm transplant eligibility and tailor pharmacotherapy. There is limited evidence regarding the most accurate method of estimating creatinine clearance (CrCl) within this patient population and no studies exist that evaluate the weight utilized within the Cockcroft-Gault (CG) equation in HCT patients. This study evaluates different weight and serum creatinine (SCr) adjustments utilized within the CG equation estimating for renal clearance in patients undergoing HCT. OBJECTIVE This is a retrospective, single center analysis of adult HCT patients who underwent pre-transplant evaluation with a measured CrCl using a 24-h urine creatinine collection. The primary outcome was to evaluate the correlation of various weights used in estimation of CrCl compared to measured CrCl. Key secondary outcomes include evaluation of the impact of various weights on estimated CrCl in subpopulations, evaluation of adjusting SCr to pre-determined limits, and determination of an appropriate obesity threshold to utilize body weight adjustments. RESULTS Seven-hundred and forty-two patients were included in the study. In the primary analysis, CG utilizing adjusted body weight (ADjBW0.4 ) had a greater correlation (r = .812) to measured CrCl when compared to total or ideal body weight (r = .801 and r = .790 respectively). The threshold of 120% of ideal body weight (IBW) produced less bias and greater accuracy in comparison to the threshold of 140% IBW. In patients 60 years or older, rounding low SCr values up .8 or 1 mg/dL resulted in decreased correlation and a greater mean difference in comparison to not rounding SCr. CONCLUSION In HCT patients who are overweight or obese, ADjBW .4 is the most accurate weight for the CG equation. In HCT patients who have a total body weight < 120% IBW, total body weight is the most accurate weight to utilize. Rounding up low SCr to .8 or 1 mg/dL does not improve the accuracy or led to less bias of the CG equation.
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Affiliation(s)
- Natasha A Emanuel
- Department of Pharmacy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Samantha Price
- Department of Pharmacy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Department of Bone marrow Transplant, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Doris K Hansen
- Department of Bone marrow Transplant, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jongphil Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Eric Gaskill
- Department of Pharmacy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Department of Bone marrow Transplant, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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2
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Lim L, Jang EJ, Jo JW, Shin J, Lee H, Lee H, Oh SY, Im H, Ryu HG. The Association Between Institutional Case Volume of Hematopoietic Stem Cell Transplantation and Mortality. Transplant Proc 2023; 55:1715-1725. [PMID: 37419732 DOI: 10.1016/j.transproceed.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is a complex, high-risk procedure with significant morbidity and mortality. The positive impact of higher institutional case volume on survival has been reported in various high-risk procedures. The association between annual institutional HSCT case volume and mortality was analyzed using the National Health Insurance Service database. METHODS Data on 16,213 HSCTs performed in 46 Korean centers between 2007 and 2018 were extracted. Centers were divided into low- or high-volume centers using an average of 25 annual cases as the cut-off. Adjusted odds ratios (OR) for 1-year mortality after allogeneic and autologous HSCT were estimated using multivariable logistic regression. RESULTS For allogeneic HSCT, low-volume centers (≤25 cases/y) were associated with higher 1-year mortality (adjusted OR 1.17, 95% CI 1.04-1.31, P = .008). However, low-volume centers did not show higher 1-year mortality (adjusted OR 1.03, 95% CI 0.89-1.19, P = .709) for autologous HSCT. Long-term mortality after HSCT was significantly worse in low-volume centers (adjusted hazard ratio [HR] 1.17, 95% CI, 1.09-1.25, P < .001 and adjusted HR 1.09, 95% CI, 1.01-1.17, P = .024, allogeneic and autologous HSCT, respectively) compared with high-volume centers. CONCLUSION Our data suggest that higher institutional HSCT case volume seems to be associated with better short- and long-term survival.
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Affiliation(s)
- Leerang Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Gyeongsangbuk-do, Korea
| | - Jun Woo Jo
- Department of Statistics, Kyungpook National University, Daegu, Korea
| | - Junghoon Shin
- Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - Hyobin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Young Oh
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyunjae Im
- Department of Critical Care Medicine, National Cancer Center, Gyeonggi-do, Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea; Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea.
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3
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Palaniyandi S, Strattan E, Kumari R, Mysinger M, Hakim N, Kesler MV, Apatira M, Bittencourt F, Wang L, Jia Z, Gururaja TL, Hill RJ, Hildebrandt GC. Combinatorial inhibition of Tec kinases BTK and ITK is beneficial in ameliorating murine sclerodermatous chronic graft versus host disease. Bone Marrow Transplant 2023; 58:924-935. [PMID: 37160943 DOI: 10.1038/s41409-023-02001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
Graft-versus-host disease (GVHD) is the major factor limiting the widespread use of potentially curative allogeneic hematopoietic stem cell transplant (allo-HSCT). Chronic GVHD is characterized by the activation of alloreactive donor immune cells, especially B- and T-cells, leading to tissue damage and pathogenic fibrosis. In this study, we used highly specific next-generation inhibitors of ITK (PCYC-274), BTK (PCYC-804), and ibrutinib-like BTK/ITK inhibitors (PCYC-914 and PCYC-401) in the B10.D2 → BALB/C model of murine sclerodermatous cGVHD. From the third week onward, allogeneic recipients in each group of respective Tec kinase inhibitors were treated three times weekly with inhibitors at doses of 10 and 30 mg/kg or with saline control via oral gavage. Overall, we found that selective BTK inhibition was less effective than combined ITK/BTK or ITK inhibition in lengthening survival and reducing symptoms of cGVHD. ITK inhibition was most efficacious, with PCYC-274 and PCYC-401 demonstrating a nearly 50 percent reduction in GVHD scoring even at the 10 mg/kg dose, while 30 mg/kg of these compounds almost completely ameliorated GVHD symptomology. BTK/ITK and ITK-treated mice showed significant reductions in overall pathology. Significant reductions in dermal thickness and fibrosis were shown for all treatment groups. There was evidence of mixed Th1 and Th2 cytokine profiles in the skin of mice with dermal cGVHD, as both IFN-gamma and IL-4 were upregulated in the allogeneic control group, while kinase inhibition significantly reduced levels of these cytokines. Using an in vitro model of T-cell polarization, Th1 cell production of TNF-alpha and IFN-gamma were partially blocked by ITK. Th2 cell production of IL-4 was almost completely blocked synergistically by ITK and BTK inhibition. BTK-specific inhibition was unable to block either Th1 or Th2 cytokine production. Taken together, these results confirm previous reports that ITK-focused inhibition inhibits Th1 and Th2 cells. Additionally, the compound's effects on T-cell proliferation were tested by CFSE assay. Pure ITK inhibition was most effective at blocking T-cell proliferation, with no proliferation in PCYC-274-treated cells even at 0.1uM. PCYC-401 and PCYC-914 showed some inhibition at lower doses, with complete inhibition evident at 10uM. PCYC-804 was only partially able to block proliferation even at 10uM. In conclusion, we observed substantial benefit for differential inhibition of Tec kinases in GVHD, with ITK being most efficacious and Th1 cells being more resistant to inhibition, matching the previously reported findings of a Th2 to Th1 selective pressure in cells treated with ibrutinib. Our data warrants the further development of ITK and ITK/BTK inhibitors with specific inhibitory ratios to improve the treatment of GVHD and other T-cell mediated diseases.
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Affiliation(s)
- Senthilnathan Palaniyandi
- Division of Hematology and Medical Oncology, Department of Medicine, Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA
- Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Ethan Strattan
- Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Reena Kumari
- Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Miranda Mysinger
- Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Natalya Hakim
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA
| | - Melissa V Kesler
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA
| | - Mutiah Apatira
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | | | - Longcheng Wang
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Zhaozhong Jia
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | | | - Ronald J Hill
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Gerhard C Hildebrandt
- Division of Hematology and Medical Oncology, Department of Medicine, Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA.
- Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA.
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4
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Fein JA, Shouval R, Galimard JE, Labopin M, Socié G, Finke J, Cornelissen JJ, Malladi R, Itälä-Remes M, Chevallier P, Orchard KH, Bunjes D, Aljurf M, Rubio MT, Versluis J, Mohty M, Nagler A. Comorbidities in transplant recipients with acute myeloid leukemia receiving low-intensity conditioning regimens: an ALWP EBMT study. Blood Adv 2023; 7:2143-2152. [PMID: 36622338 PMCID: PMC10206431 DOI: 10.1182/bloodadvances.2022008656] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/22/2022] [Accepted: 12/19/2022] [Indexed: 01/10/2023] Open
Abstract
Older age and a high burden of comorbidities often drive the selection of low-intensity conditioning regimens in allogeneic hematopoietic stem cell transplantation recipients. However, the impact of comorbidities in the low-intensity conditioning setting is unclear. We sought to determine the contribution of individual comorbidities and their cumulative burden on the risk of nonrelapse mortality (NRM) among patients receiving low-intensity regimens. In a retrospective analysis of adults (≥18 years) who underwent transplantation for acute myeloid leukemia in the first complete remission between 2008 and 2018, we studied recipients of low-intensity regimens as defined by the transplantation conditioning intensity (TCI) scale. Multivariable Cox models were constructed to study associations of comorbidities with NRM. Comorbidities identified as putative risk factors in the low-TCI setting were included in combined multivariable regression models assessed for overall survival, NRM, and relapse. A total of 1663 patients with a median age of 61 years received low-TCI regimens. Cardiac comorbidity (including arrhythmia/valvular disease) and psychiatric disease were associated with increased NRM risk (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.13-2.09 and HR, 1.69; 95% CI, 1.02-2.82, respectively). Moderate pulmonary dysfunction, though prevalent, was not associated with increased NRM. In a combined model, cardiac, psychiatric, renal, and inflammatory bowel diseases were independently associated with adverse transplantation outcomes. These findings may inform patient and regimen selection and reinforce the need for further investigation of cardioprotective transplantation approaches.
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Affiliation(s)
- Joshua A. Fein
- Department of Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York-Presbyterian, New York, NY
| | - Roni Shouval
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY
| | - Jacques-Emmanuel Galimard
- Hematology Department, Hôpital Saint-Antoine, Paris, France
- Clinical Hematology and Cellular Therapy Department, Sorbonne University, Paris, France
- INSERM UMR 938, Paris, France
- European Society for Blood and Marrow Transplantation Statistical Unit, Hôpital Saint-Antoine, Paris, France
| | - Myriam Labopin
- Hematology Department, Hôpital Saint-Antoine, Paris, France
- Clinical Hematology and Cellular Therapy Department, Sorbonne University, Paris, France
- INSERM UMR 938, Paris, France
| | - Gérard Socié
- Hematology and Transplantation Unit, Hôpital Saint Louis, AP-HP, Paris, France
| | - Jürgen Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan J. Cornelissen
- Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Ram Malladi
- Centre for Clinical Haematology, University of Birmingham, Birmingham, United Kingdom
| | - Maija Itälä-Remes
- Department of Clinical Hematology and Stem Cell Transplant Unit, Turku University Hospital, Turku, Finland
| | | | - Kim H. Orchard
- Wessex Blood and Marrow Transplant and Cellular Therapy Program, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Donald Bunjes
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudia Arabia
| | - Marie Thérèse Rubio
- Department of Hematology and Bone Marrow Transplantation, Hôpitaux de Brabois, Nancy, France
| | - Jurjen Versluis
- Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Mohamad Mohty
- Hematology Department, Hôpital Saint-Antoine, Paris, France
- Clinical Hematology and Cellular Therapy Department, Sorbonne University, Paris, France
- INSERM UMR 938, Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
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5
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Fraint E, Abdel-Azim H, Bhatt NS, Broglie L, Chattha A, Kohorst M, Ktena YP, Lee MA, Long S, Qayed M, Sharma A, Stefanski H, Vatsayan A, Wray L, Hamadani M, Carpenter PA. Evaluation of Children with Malignancies for Blood and Marrow Transplantation: A Report from the ASTCT Committee on Practice Guidelines. Transplant Cell Ther 2023; 29:293-301. [PMID: 36775202 DOI: 10.1016/j.jtct.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
Evaluation of a candidate for hematopoietic cell transplantation (HCT) is a complex process with substantial intercenter variability. Although literature providing guidance for evaluating the eligibility of adults is well established, similar guidance for children is lacking. To address gaps between adult recommendations and the specific needs of children, we convened a panel of pediatric HCT experts from a wide geographic range of American Society of Transplantation and Cellular Therapy (ASTCT) member institutions to offer recommendations for pediatric-focused pre-HCT evaluation. In this report from the ASTCT Committee on Practice Guidelines, we present a practical framework for evaluating children with malignancies who are candidates for HCT. We also highlight key differences from adults and emphasize areas of unmet need that require additional research to delineate best practices.
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Affiliation(s)
- Ellen Fraint
- Division of Pediatric Hematology, Oncology, and Cellular Therapy, Children's Hospital at Montefiore, Bronx, New York.
| | - Hisham Abdel-Azim
- Loma Linda University School of Medicine, Cancer Center, Children's Hospital and Medical Center, Loma Linda, California
| | - Neel S Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Larisa Broglie
- Medical College of Wisconsin, Department of Pediatrics, Division of Pediatric Hematology/Oncology/Blood and Marrow Transplantation, Milwaukee, Wisconsin
| | - Asma Chattha
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mira Kohorst
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yiouli P Ktena
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michelle A Lee
- Division of Pediatric Hematology, Oncology, and Cellular Therapy, Children's Hospital at Montefiore, Bronx, New York
| | - Susie Long
- University of Minnesota Masonic Children's Hospital, MHealth Fairview Acute Care Pharmacy Services, Minneapolis, Minnesota
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Anant Vatsayan
- Children's National Medical Center, Washington, District of Columbia
| | - Lisa Wray
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
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6
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Wudhikarn K, Johnson BM, Inwards DJ, Porrata LF, Micallef IN, Ansell SM, Hogan WJ, Paludo J, Villasboas JC, Johnston PB. Outcomes of Older Adults with Non-Hodgkin Lymphoma Undergoing Autologous Stem Cell Transplantation: A Mayo Clinic Cohort Analysis. Transplant Cell Ther 2023; 29:176.e1-176.e8. [PMID: 36563788 DOI: 10.1016/j.jtct.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
Autologous stem cell transplantation (ASCT) is an important treatment that can offer a cure for patients with lymphoma. However, advanced age is an important factor that determines eligibility and outcomes after ASCT. Over the past decade, attributed to improved supportive care, ASCT for older patients has become more feasible. In this study, we report the single-center outcomes of older patients with lymphoma undergoing ASCT at Mayo Clinic Rochester to highlight its interval improvement over time and to help redefine the implications of ASCT in the chimeric antigen receptor T cell therapy era. This single-center retrospective study evaluated the characteristics and outcomes of older patients with lymphoma who underwent ASCT between 2000 and 2021. We report various relevant transplantation-related outcomes, including progression-free survival, overall survival (OS), relapse incidence, and nonrelapse mortality (NRM) in older patients with various lymphoma histologic subtypes. The main outcome was NRM, defined as the time from ASCT to non-lymphoma-related death, with relapse as a competing event. Of 492 patients age ≥65 years were analyzed. The median age at ASCT was 68.8 years. The most common indication for ASCT was diffuse large B cell lymphoma, accounting for 59.3% of cases. In multivariate analyses, patients undergoing ASCT in 2009 to 2021, an Eastern Cooperative Oncology Group Performance Status of 0, and low Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) (0 to 3) had a significantly lower NRM. Factors associated with OS included age, lactate dehydrogenase level, and HCT-CI. The 1-year NRM in older patients was low at 6.0%, in concordance with previous reports. Age should not be the sole factor determining a patient's ASCT eligibility. With the proper patient selection, ASCT remains a reasonable option for older patients with lymphoma.
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Affiliation(s)
- Kitsada Wudhikarn
- Division of Hematology, Mayo Clinic, Rochester, Minnesota; Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Bradley M Johnson
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | - Luis F Porrata
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Willam J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
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7
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ABCs of ADCs in Management of Relapsed/refractory diffuse large B-cell lymphoma. Blood Rev 2022; 56:100967. [DOI: 10.1016/j.blre.2022.100967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022]
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8
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Kennedy VE, Olin RL. Haematopoietic stem-cell transplantation in older adults: geriatric assessment, donor considerations, and optimisation of care. LANCET HAEMATOLOGY 2021; 8:e853-e861. [PMID: 34624239 DOI: 10.1016/s2352-3026(21)00231-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Haematopoietic stem-cell transplantation (HSCT) has seen substantial growth among older adults. Chronological age is no longer viewed as an absolute barrier to HSCT, and alternative methods for assessing pre-transplantation fitness are increasingly used. In this Series paper, we summarise the metrics for pre-transplantation risk assessment in older adults, including both traditional metrics and geriatric assessment, and the ability of these metrics to predict post-transplantation outcomes. We also discuss strategies to broaden the utility of geriatric assessment, including in chronologically younger HSCT candidates and to guide individualised pre-transplantation interventions. Finally, we discuss donor considerations in older adults, including use of older sibling donors, haploidentical donors, and emerging data for donor-associated clonal haematopoiesis of indeterminate potential.
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Affiliation(s)
- Vanessa E Kennedy
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca L Olin
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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9
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Al-Shaibani E, Cyriac S, Chen S, Lipton JH, Kim DD, Viswabandya A, Kumar R, Lam W, Law A, Al-Shaibani Z, Gerbitz A, Pasic I, Mattsson J, Michelis FV. Comparison of the Prognostic Ability of the HCT-CI, the Modified EBMT, and the EBMT-ADT Pre-transplant Risk Scores for Acute Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e559-e568. [PMID: 33678592 DOI: 10.1016/j.clml.2021.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Allogeneic hematopoietic cell transplantation (HCT) outcomes may be predicted by published risk scores; however, the ideal system has not been identified for acute leukemias. PATIENTS AND METHODS We retrospectively examined the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI), modified European Group for Blood and Marrow Transplantation (mEBMT), EBMT-Alternating Decision Tree (ADT), and others on 231 patients with acute leukemia. RESULTS Acute myeloid leukemia was diagnosed in 200 patients, and acute lymphocytic leukemia was diagnosed in 31 patients. For HCT-CI, patients were grouped as 0 to 1, 2 to 3, and > 3. For mEBMT, patients were grouped as 0 to 2, 3, and > 3. For EBMT-ADT, the 100-day mortality was calculated and grouped as ≤ 4.1%, 4.1% to 11.5%, and > 11.5%. Higher HCI-CI demonstrated inferior overall survival (P = .04; c-statistic, 0.57), whereas mEBMT and EBMT-ADT did not stratify well. A new weighted score was developed that assigned 1 point for age ≥ 60 years, acute lymphocytic leukemia diagnosis, mismatch unrelated or haploidentical donor, cardiovascular comorbidity, and pre-transplant diabetes, whereas arrhythmia received 2 points. The new weighted score assigned 0 points to 88 (38%), 1 to 2 points to 121 (52%) and ≥ 3 points to 22 (10%) patients, and demonstrated improved prognostic capability compared with the other scores (P = .0001; c-statistic, 0.61). CONCLUSIONS The HCT-CI stratifies patients with leukemia for overall survival but is inferior to our single-center score, which is influenced by cardiac comorbidity and arrhythmia. Differences in pre-transplant risk scores may be related to different transplant practices.
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Affiliation(s)
- Eshrak Al-Shaibani
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sunu Cyriac
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shiyi Chen
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jeffrey H Lipton
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Dennis D Kim
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Auro Viswabandya
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rajat Kumar
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Wilson Lam
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Arjun Law
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Zeyad Al-Shaibani
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Armin Gerbitz
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ivan Pasic
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jonas Mattsson
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Fotios V Michelis
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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10
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Ferdjallah A, Young JAH, MacMillan ML. A Review of Infections After Hematopoietic Cell Transplantation Requiring PICU Care: Transplant Timeline Is Key. Front Pediatr 2021; 9:634449. [PMID: 34386464 PMCID: PMC8353083 DOI: 10.3389/fped.2021.634449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Despite major advances in antimicrobial prophylaxis and therapy, opportunistic infections remain a major cause of morbidity and mortality after pediatric hematopoietic cell transplant (HCT). Risk factors associated with the development of opportunistic infections include the patient's underlying disease, previous infection history, co-morbidities, source of the donor graft, preparative therapy prior to the graft infusion, immunosuppressive agents, early and late toxicities after transplant, and graft-vs.-host disease (GVHD). Additionally, the risk for and type of infection changes throughout the HCT course and is greatly influenced by the degree and duration of immunosuppression of the HCT recipient. Hematopoietic cell transplant recipients are at high risk for rapid clinical decompensation from infections. The pediatric intensivist must remain abreast of the status of the timeline from HCT to understand the risk for different infections. This review will serve to highlight the infection risks over the year-long course of the HCT process and to provide key clinical considerations for the pediatric intensivist by presenting a series of hypothetical HCT cases.
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Affiliation(s)
- Asmaa Ferdjallah
- Department of Pediatrics, Division of Blood and Marrow Transplantation and Cellular Therapy, University of Minnesota, Minneapolis, MN, United States
| | - Jo-Anne H Young
- Department of Medicine, Division of Infectious Disease and International Medicine, Program in Transplant Infectious Disease, University of Minnesota, Minneapolis, MN, United States
| | - Margaret L MacMillan
- Department of Pediatrics, Division of Blood and Marrow Transplantation and Cellular Therapy, University of Minnesota, Minneapolis, MN, United States
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Kanate AS, Perales MA, Hamadani M. Eligibility Criteria for Patients Undergoing Allogeneic Hematopoietic Cell Transplantation. J Natl Compr Canc Netw 2020; 18:635-643. [PMID: 32380457 DOI: 10.6004/jnccn.2020.7559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/10/2020] [Indexed: 11/17/2022]
Abstract
Eligibility assessment of a potential candidate for allogeneic hematopoietic cell transplantation (allo-HCT) is a complex yet vital component of pretransplant evaluation. Although no formal standardized consensus exists to guide this process, transplant centers follow institutional standard operating procedures and parameters to approve candidacy of an individual patient. Consideration for allo-HCT is dependent on a myriad of interrelated factors, including disease-related (eg, appropriate indication, disease status, prior therapies), patient-related (eg, age, functional status, frailty, comorbidities), psychosocial, and economic factors. A multidisciplinary approach is optimal for patient selection and requires the efforts of transplant coordinators, nurses, advanced practice providers, social workers, psychologists, financial specialists, and physicians. This article reviews the data and provides general guidelines that may be used in making an informed decision when evaluating a prospective candidate for allo-HCT. These recommendations are based on published data, expert commentary, reviews, and institutional practices. In the end, the eligibility assessment and decision to consider allo-HCT as the optimal choice of treatment for an individual patient are truly as much an "art" as it is the "science" of medicine, encompassing a multidisciplinary approach to minimize harm without compromising the curative potential-all essential doctrines of the Hippocratic Oath.
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Affiliation(s)
- Abraham S Kanate
- 1Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Miguel-Angel Perales
- 2Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Mehdi Hamadani
- 3BMT & Cellular Therapy Program, and.,4Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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12
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Dionne-Odom JN, Currie ER, Johnston EE, Rosenberg AR. Supporting Family Caregivers of Adult and Pediatric Persons with Leukemia. Semin Oncol Nurs 2019; 35:150954. [DOI: 10.1016/j.soncn.2019.150954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Raoufinejad K, Shamshiri AR, Pezeshki S, Chahardouli B, Hadjibabaie M, Jahangard-Rafsanjani Z, Gholami K, Rajabi M, Vaezi M. Oral calcitriol in hematopoietic recovery and survival after autologous stem cell transplantation: a randomized clinical trial. Daru 2019; 27:709-720. [PMID: 31713184 PMCID: PMC6895337 DOI: 10.1007/s40199-019-00306-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Calcitriol, the active metabolite of vitamin D, is an essential regulator in the hematopoiesis and immunity. However, knowledge revealing its influence on the immune and hematologic reconstitution after hematopoietic stem cell transplantation (HSCT) in clinical trials is very limited. OBJECTIVES The effects of calcitriol on short-term and long-term hematopoietic recovery, relapse-free survival (RFS) and overall survival (OS) in multiple myeloma, Hodgkin's and non-Hodgkin's lymphoma following autologous peripheral blood HSCT were assessed. METHODS Eighty patients (age: 18-68 years) in complete remission were allocated 1:1 to two groups by balanced block randomization. Calcitriol 0.25 μg or placebo capsule was administered three times daily from transplantation to day 30. Absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and platelet count (PC) were determined daily from transplantation to day 30. White blood cell count (WBC), PC, and hemoglobin concentration (HC) of days 180 and 365 were extracted from clinic files. A thorough examination for oral mucositis (OM) was completed daily during hospital stay. Adverse drug reactions (ADRs) as well as two-year RFS and OS were evaluated. RESULTS Median time to ANC engraftment (≥0.5 × 103/μl: 10.0 vs. 11.0 days; P = 0.98) and PC engraftment (≥20.0 × 103/μl: both 14.0 days; P = 0.58) was similar between groups. However, the median time to ALC recovery was significantly shorter in the calcitriol group (≥0.5 × 103/μl: 13.0 vs. 20.0 days; P < 0.001). Moreover, ALC recovery rates on day 15 (≥0.5 × 103/μl: 82.1% vs. 42.5%; P < 0.001) and on day 30 (≥1.0 × 103/μl: 91.7% vs. 57.5%; P = 0.001) was significantly higher with calcitriol. WBC, PC, and HC on days 180 and 365 were not significantly different between groups. None of the OM indices were modulated by calcitriol. All the ADRs were non-serious and mild, possibly or unlikely related to the intervention. In a median of 29 months follow-up, RFS was significantly better in the calcitriol group (77.0%, SE = 7.0% vs. 59.0%, SE = 8.0%; P = 0.03), albeit the OS was not affected (87.0%, SE = 5.0% vs. 92.0%, SE = 4.0%; P = 0.72). CONCLUSION Calcitriol could improve ALC recovery and RFS as a safe option post-HSCT. Graphical abstract Oral calcitriol 0.25 µg three times daily from transplantation to day 30 improved lymphocytes recovery and two-year relapse-free survival as a safe option in 80 patients of autologous hematopoietic stem cell transplantation in comparison with placebo.
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Affiliation(s)
- Kosar Raoufinejad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, PO Box 14155/6451, 16 Azar Ave., Inqelab Sq., Tehran, Iran
| | - Ahmad Reza Shamshiri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Pezeshki
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Islamic Azad University of Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Bahram Chahardouli
- Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Molouk Hadjibabaie
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, PO Box 14155/6451, 16 Azar Ave., Inqelab Sq., Tehran, Iran.
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Jahangard-Rafsanjani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, PO Box 14155/6451, 16 Azar Ave., Inqelab Sq., Tehran, Iran
| | - Kheirollah Gholami
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, PO Box 14155/6451, 16 Azar Ave., Inqelab Sq., Tehran, Iran
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rajabi
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Islamic Azad University of Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
- Department of Clinical Pharmacy, University Hospitals of North Midlands, Stoke-on-Trent, Staffordshire, UK
| | - Mohammad Vaezi
- Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Nakamura ZM, Nash RP, Quillen LJ, Richardson DR, McCall RC, Park EM. Psychiatric Care in Hematopoietic Stem Cell Transplantation. PSYCHOSOMATICS 2019; 60:227-237. [PMID: 30733043 DOI: 10.1016/j.psym.2019.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with cancer frequently experience neuropsychiatric symptoms due to their medical illness or its treatment. In recent decades, psychiatrists have become increasingly involved in the care of patients with cancer. However, psychiatrists may be less familiar with hematopoietic stem cell transplantation (HSCT), a distinct cancer treatment modality associated with multiple neuropsychiatric sequelae. OBJECTIVE To provide an overview of HSCT, and describe the prevalence, impact, risk factors, and suggested management of psychiatric consequences of HSCT. METHODS We performed literature searches in PubMed and PsychInfo to identify articles describing neuropsychiatric symptoms, including depression, anxiety, distress, post-traumatic stress disorder, delirium and cognitive impairment, resulting from HSCT in adults. Those articles most relevant to this manuscript were included. RESULTS Psychiatrists may be involved in the treatment of patients before, during, or after inpatient hospitalization for HSCT. Each phase of treatment introduces unique stressors that may lead to or exacerbate psychiatric disorders. Appropriate management requires evaluation of HSCT-related medications, an understanding of the impact of complications from HSCT, and consideration of how the patient's underlying medical condition should influence psychiatric recommendations. CONCLUSION To optimize patient outcomes, consulting psychiatrists should be familiar with the basic principles of HSCT, and the neuropsychiatric sequelae that may result from treatment. Further research is needed to identify strategies to manage psychiatric complications in this unique population.
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Affiliation(s)
- Zev M Nakamura
- Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, NC.
| | - Rebekah P Nash
- Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, NC
| | - Laura J Quillen
- Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, NC
| | - Daniel R Richardson
- Lineberger Comprehensive Cancer Center, University of North Carolina - Chapel Hill, Chapel Hill, NC; The Cecil G. Sheps Center for Health Services Research, University of North Carolina - Chapel Hill, Chapel Hill, NC
| | - Rebecca C McCall
- Health Sciences Library, University of North Carolina - Chapel Hill, Chapel Hill, NC
| | - Eliza M Park
- Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina - Chapel Hill, Chapel Hill, NC; Department of Medicine, University of North Carolina - Chapel Hill, Chapel Hill, NC
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15
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Jurczak W, Długosz-Danecka M, Rivas Navarro F. The rationale for combination therapy in patients with aggressive B-cell non-Hodgkin lymphoma: ten questions. Future Oncol 2019; 15:305-317. [DOI: 10.2217/fon-2018-0388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone immunochemotherapy remains standard of care for first-line treatment of diffuse large B-cell lymphoma (DLBCL). High-dose chemotherapy and stem cell transplantation is offered to most relapsing/refractory patients who respond to salvage therapy. This Q&A review evaluates recommended management strategies for second and subsequent lines of therapy in patients with DLBCL, outlining the relative efficacies of currently available options including novel agents such as ibrutinib and CAR-T cells. The combination of pixantrone and rituximab is currently under investigation as a second-line treatment for patients ineligible for stem cell transplantation, while pixantrone monotherapy is the only therapeutic option approved for multiply relapsed and refractory DLBCL beyond the second line at this time.
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Affiliation(s)
- Wojciech Jurczak
- Department of Hematology, Jagiellonian University, Kraków 31-501, Poland
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16
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Li T, Mallick R, McCurdy A, Mulpuru S, Huebsch L, Bredeson C, Allan D, Kekre N. Are We Choosing Wisely With Autologous Hematopoietic Cell Transplantation Screening? The Utility of Pulmonary Function Testing Prior to Autologous Hematopoietic Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 19:68-72. [PMID: 30552014 DOI: 10.1016/j.clml.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/24/2018] [Accepted: 11/02/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite the risk of morbidity and mortality associated with autologous hematopoietic cell transplantation (ASCT), there are no clear guidelines as to how to screen for these risks. This study sought to determine the utility of pulmonary function tests (PFTs) prior to ASCT on predicting posttransplant clinical outcomes. PATIENTS AND METHODS Patients undergoing ASCT between 2010 and 2012 at the Ottawa Hospital (n = 172) were reviewed. PFT results prior to ASCT were retrieved. The primary outcomes were incidence of intensive care unit (ICU) admission, Seattle Criteria for pulmonary toxicities, and transplant-related mortality (TRM). RESULTS PFTs were performed for 91 (53%) patients prior to ASCT. There were more smokers in the PFT cohort than the non-PFT cohort (41.8% vs. 19.8%, respectively; P < .0001). Pulmonary toxicity as measured by the Seattle Criteria did not correlate with PFT results (normal vs. abnormal, 8.1% and 6.1%, respectively; P = 1.00). There were no differences in incidence of ICU admission by PFT result (normal vs. abnormal, 2.7% vs. 8.2%, respectively; P = .61) and no difference in TRM by PFT result (normal vs. abnormal, 0% vs. 2.0%, respectively; P = 1.00). CONCLUSION Despite testing patients deemed higher risk for pulmonary toxicity, abnormal PFTs did not predict for an increased risk of pulmonary toxicity, ICU admission, or TRM at our center.
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Affiliation(s)
- Tony Li
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- School of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Arleigh McCurdy
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lothar Huebsch
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chris Bredeson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Allan
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Natasha Kekre
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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17
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Hierlmeier S, Eyrich M, Wölfl M, Schlegel PG, Wiegering V. Early and late complications following hematopoietic stem cell transplantation in pediatric patients - A retrospective analysis over 11 years. PLoS One 2018; 13:e0204914. [PMID: 30325953 PMCID: PMC6191171 DOI: 10.1371/journal.pone.0204914] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/17/2018] [Indexed: 01/10/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) has been an effective method for treating a wide range of malignant or non-malignant disorders. In case of an autologous HSCT, patients receive their own stem cells after myeloablation before extraction. Allogeneic HSCT uses stem cells derived from a donor. Despite being associated with a high risk of early and long-term complications, it is often the last curative option. 229 pediatric patients, who between 1 January 2005 and 31 December 2015 received an HSCT at the University Children’s Hospital Wuerzburg, were studied. Correlations between two groups were calculated with the Chi square test or with a 2x2-contingency table. To calculate metric variables, the Mann-Whitney-U-test was used. Survival curves were calculated according to Kaplan and Meier. Significance was assumed for results with a p-value <0.05 (CI (Confident Interval) 95%). We retrospectively analyzed 229 pediatric patients (105 females, 124 males) for early and late complications of allogeneic and autologous hematopoietic stem cell transplantation. Median age at HSCT was seven years. Underlying diseases were leukemia (n = 73), lymphoma (n = 22), solid tumor (n = 65), CNS (central nervous system)- tumor (n = 41), and “other diseases” (n = 28). Survival times, overall survival, and event-free survival were calculated. Of all patients, 80.8% experienced complications of some degree, including mild and transient complications. Allo-HSCT (allogeneic HSCT) carried a significantly higher risk of complications than auto-HSCT (autologous HSCT) (n = 118 vs. n = 67; p = < .001) and the remission rate after allo-HSCT was also higher (58.7% vs. 44,7%; p = .032). Especially infection rates and pulmonary complications are different between auto- and allo-HSCT. Leukemia patients had the highest risk of early and late complications (95,0%; p < .001). Complications within HSCT are major risk factors following morbidity and mortality. In order to detect complications and risk factors early, strict recordings are needed to reduce the rate of complication by recognition and prevention of triggering factors. In the future, these factors should receive greater attention in the planning of HSCT post-transplantation care in order to improve the results of the transplantation and establish protocols to prevent their occurrence.
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Affiliation(s)
- Sophie Hierlmeier
- University Hospital Wuerzburg, Children’s Department of Oncology, Hematology and Stem Cell Transplantation, Wuerzburg, Germany
| | - Matthias Eyrich
- University Hospital Wuerzburg, Children’s Department of Oncology, Hematology and Stem Cell Transplantation, Wuerzburg, Germany
| | - Matthias Wölfl
- University Hospital Wuerzburg, Children’s Department of Oncology, Hematology and Stem Cell Transplantation, Wuerzburg, Germany
| | - Paul-Gerhardt Schlegel
- University Hospital Wuerzburg, Children’s Department of Oncology, Hematology and Stem Cell Transplantation, Wuerzburg, Germany
| | - Verena Wiegering
- University Hospital Wuerzburg, Children’s Department of Oncology, Hematology and Stem Cell Transplantation, Wuerzburg, Germany
- * E-mail:
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Caregiver Sleep and Patient Neutrophil Engraftment in Allogeneic Hematopoietic Stem Cell Transplant: A Secondary Analysis. Cancer Nurs 2018; 41:77-85. [PMID: 27922914 DOI: 10.1097/ncc.0000000000000447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Caregiving for allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients can be significantly burdensome. Caregiver well-being often mirrors patients' suffering. However, to our knowledge, this dyadic relationship has not been linked to patient outcome. OBJECTIVE Caregiver's objective and subjective sleep and overall distress before transplantation were hypothesized to be related to patient's time to engraftment in secondary analyses. METHODS Dyads (N = 124) were Allo-HSCT patients (mean [SD] age, 49.2 [12.7] years) and their caregivers (mean [SD] age, 52.7 [12.3] years). Caregiver's subjective sleep quality was measured via the Pittsburgh Sleep Quality Index, objective sleep was measured by actigraphy, and distress was measured by combining validated psychological measures. RESULTS Both caregiver reports of worse sleep (β = .22; P < .05) and objective measurement of caregiver sleep patterns (higher sleep efficiency; less time awake after sleep onset) collected before engraftment significantly predicted shorter time to patient engraftment (β values = -.34 and .29, respectively; P values < .05). Caregiver distress was unrelated to engraftment (β = .14; P = .22). CONCLUSIONS Despite limitations in available patient data, these findings appear to link caregiver well-being to patient outcome. This underscores the interrelatedness of the patient-caregiver dyad in Allo-HSCT. Future research should examine psychological and biomedical mediators. IMPLICATIONS FOR PRACTICE Given that caregiver well-being during the peritransplantation period was associated with patient outcome in this study, such findings highlight the need to address caregiver and patient well-being during Allo-HSCT. There may be potential to improve patient outcome by focusing on the caregiver, which nursing staff is well positioned to monitor.
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Tay J, Daly A, Jamani K, Labelle L, Savoie L, Stewart D, Storek J, Beattie S. Patient eligibility for hematopoietic stem cell transplantation: a review of patient-associated variables. Bone Marrow Transplant 2018; 54:368-382. [PMID: 29988063 DOI: 10.1038/s41409-018-0265-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/30/2018] [Accepted: 06/06/2018] [Indexed: 02/07/2023]
Abstract
Assessing patient eligibility for hematopoietic stem cell transplantation (HSCT) remains a complex, multifaceted challenge. Among these challenges, the paucity of comprehensive clinical data to guide decision making remains problematic coupled with unclear trade-offs between patient, disease and local HSCT center factors. Moreover, it is unclear that the modification of poor patient characteristics will improve post-HSCT outcomes. However, the use of Comorbidity Indices and Comprehensive Geriatric Assessments helps meet this challenge, but may be limited by overlapping patient characteristics. The increasing consideration for pre-HSCT psychosocial assessments and interventions remains to be studied. Ultimately, the decision to proceed with a HSCT remains interdisciplinary while considering the available evidence discussed in this review.
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Affiliation(s)
- J Tay
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
| | - A Daly
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - K Jamani
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - L Labelle
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - L Savoie
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - D Stewart
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - J Storek
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - S Beattie
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
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Snowden JA, Panés J, Alexander T, Allez M, Ardizzone S, Dierickx D, Finke J, Hasselblatt P, Hawkey C, Kazmi M, Lindsay JO, Onida F, Salas A, Saccardi R, Vermeire S, Rovira M, Ricart E. Autologous Haematopoietic Stem Cell Transplantation (AHSCT) in Severe Crohn's Disease: A Review on Behalf of ECCO and EBMT. J Crohns Colitis 2018; 12:476-488. [PMID: 29325112 DOI: 10.1093/ecco-jcc/jjx184] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 01/04/2018] [Indexed: 02/06/2023]
Abstract
Despite the major recent progress in the treatment of Crohn's disease [CD], there is a subset of patients in whom the disease runs an aggressive course with progressive tissue damage requiring early and repeated surgical management. Increasing evidence supports sustained and profound improvement in gastrointestinal parameters and quality of life following high-dose immunosuppressive therapy and autologous haematopoietic stem cell transplantation [AHSCT] compared to standard therapy in this context. In addition, international transplant registry data reflect the use of AHSCT in CD outside of trials in selected patients. However, AHSCT may be associated with significant treatment-related complications with risk of transplant-related mortality. In a joint initiative, the European Crohn's and Colitis Organisation [ECCO] and the European Society for Blood and Marrow Transplantation [EBMT] have produced a state-of-the-art review of the rationale, evaluation, patient selection, stem cell mobilization and transplant procedures and long-term follow up. Given the unique spectrum of issues, we recommend that AHSCT should only be performed in experienced centres with expertise in both haematological and gastroenterological aspects of the procedure. Where possible, patients should be enrolled on clinical trials and data registered centrally. Future development should be coordinated at both national and international levels.
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Affiliation(s)
- John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Julián Panés
- Department of Gastroenterology, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine, Berlin, Germany
| | - Matthieu Allez
- Department of Gastroenterology, Hôpital Saint Louis, APHP, INSERM U1160, Paris Diderot, Sorbonne Paris-Cité University, Paris, France
| | - Sandro Ardizzone
- DIBIC - ASST Fatebenefratelli Sacco - University of Milan, Italy
| | - Daan Dierickx
- Department of Haematology, University Hospitals, Leuven, Belgium
| | - Jürgen Finke
- Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Peter Hasselblatt
- Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Chris Hawkey
- Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Majid Kazmi
- Department of Haematology, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - James O Lindsay
- The Royal London Hospital, Barts Health NHS Trust, London UK & Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Francesco Onida
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Italy
| | - Azucena Salas
- Department of Gastroenterology, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Riccardo Saccardi
- Department of Haematology, Careggi University Hospital, Firenze, Italy
| | - Severine Vermeire
- Department of Gastroenterology - University Hospitals, Leuven, Belgium
| | - Montserrat Rovira
- BMT Unit, Hematology Department, IDIBAPS, Hospital Clinic. Josep Carreras Leukaemia Research Institute (IJC), Barcelona, Spain
| | - Elena Ricart
- Department of Gastroenterology, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
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Wroblewski M, Scheller-Wendorff M, Udonta F, Bauer R, Schlichting J, Zhao L, Ben Batalla I, Gensch V, Päsler S, Wu L, Wanior M, Taipaleenmäki H, Bolamperti S, Najafova Z, Pantel K, Bokemeyer C, Qi J, Hesse E, Knapp S, Johnsen S, Loges S. BET-inhibition by JQ1 promotes proliferation and self-renewal capacity of hematopoietic stem cells. Haematologica 2018; 103:939-948. [PMID: 29567778 PMCID: PMC6058788 DOI: 10.3324/haematol.2017.181354] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/15/2018] [Indexed: 12/25/2022] Open
Abstract
Although inhibitors of bromodomain and extra terminal domain (BET) proteins show promising clinical activity in different hematologic malignancies, a systematic analysis of the consequences of pharmacological BET inhibition on healthy hematopoietic (stem) cells is urgently needed. We found that JQ1 treatment decreases the numbers of pre-, immature and mature B cells while numbers of early pro-B cells remain constant. In addition, JQ1 treatment increases apoptosis in T cells, all together leading to reduced cellularity in thymus, bone marrow and spleen. Furthermore, JQ1 induces proliferation of long-term hematopoietic stem cells, thereby increasing stem cell numbers. Due to increased numbers, JQ1-treated hematopoietic stem cells engrafted better after stem cell transplantation and repopulated the hematopoietic system significantly faster after sublethal myeloablation. As quantity and functionality of hematopoietic stem cells determine the duration of life-threatening myelosuppression, BET inhibition might benefit patients in myelosuppressive conditions.
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Affiliation(s)
- Mark Wroblewski
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marina Scheller-Wendorff
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Germany
| | - Florian Udonta
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raimund Bauer
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jara Schlichting
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lin Zhao
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Isabel Ben Batalla
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria Gensch
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarina Päsler
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lei Wu
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Marek Wanior
- Institute for Pharmaceutical Chemistry, Johann Wolfgang Goethe-University and Buchmann Institute for Molecular Life Sciences, Frankfurt am Main, Germany
| | - Hanna Taipaleenmäki
- Heisenberg-Group for Molecular Skeletal Biology, Department of Trauma, Hand & Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simona Bolamperti
- Heisenberg-Group for Molecular Skeletal Biology, Department of Trauma, Hand & Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zeynab Najafova
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Germany
| | - Klaus Pantel
- Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Qi
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Eric Hesse
- Heisenberg-Group for Molecular Skeletal Biology, Department of Trauma, Hand & Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Knapp
- Institute for Pharmaceutical Chemistry, Johann Wolfgang Goethe-University and Buchmann Institute for Molecular Life Sciences, Frankfurt am Main, Germany.,Nuffield Department of Clinical Medicine, Structural Genomics Consortium and Target Discovery Institute, University of Oxford, Old Road Campus Research Building, UK.,German Cancer Consortium (DKTK) Frankfurt am Main, Germany
| | - Steven Johnsen
- Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Germany
| | - Sonja Loges
- Department of Hematology and Oncology with Sections BMT and Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany .,Institute of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Booker R, Simon J, Biondo P, Bouchal SR. Perspectives on advance care planning in haematopoietic stem cell transplantation: a qualitative study. Int J Palliat Nurs 2018; 24:132-144. [DOI: 10.12968/ijpn.2018.24.3.132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Reanne Booker
- Nurse Practitioner, Alberta Health Services, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jessica Simon
- Associate Professor, Palliative Care Physician, Department of Oncology, University of Calgary, Calgary, Alberta
| | - Patricia Biondo
- Research Manager, Advance Care Planning CRIO Program, University of Calgary, Calgary, Alberta
| | - Shelley Raffin Bouchal
- Associate Dean (Graduate Programmes), Associate Professor, Faculty of Nursing, University of Calgary, Alberta
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23
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Rini C, Symes Y, Campo RA, Wu LM, Austin J. I Keep my Problems to Myself: Negative Social Network Orientation, Social Resources, and Health-Related Quality of Life in Cancer Survivors. Ann Behav Med 2017; 50:385-96. [PMID: 26693932 DOI: 10.1007/s12160-015-9765-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cancer survivors treated with hematopoietic stem cell transplant rely on their social network for successful recovery. However, some survivors have negative attitudes about using social resources (negative social network orientation) that are critical for their recovery. PURPOSE We examined the association between survivors' social network orientation and health-related quality of life (HRQoL) and whether it was mediated by social resources (network size, perceived support, and negative and positive support-related social exchanges). METHODS In a longitudinal study, 255 survivors completed validated measures of social network orientation, HRQoL, and social resources. Hypotheses were tested using path analysis. RESULTS More negative social network orientation predicted worse HRQoL (p < .001). This association was partially mediated by lower perceived support and more negative social exchanges. CONCLUSIONS Survivors with negative social network orientation may have poorer HRQoL in part due to deficits in several key social resources. Findings highlight a subgroup at risk for poor transplant outcomes and can guide intervention development.
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Affiliation(s)
- Christine Rini
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Campus box 7440, 319C Rosenau Hall, Chapel Hill, NC, 27599-7440, USA.
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
| | - Yael Symes
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Campus box 7440, 319C Rosenau Hall, Chapel Hill, NC, 27599-7440, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Rebecca A Campo
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa M Wu
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Jane Austin
- Department of Psychology, William Paterson University, Wayne, NJ, USA
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24
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Khalil MMI, Lipton JH, Atenafu EG, Gupta V, Kim DD, Kuruvilla J, Viswabandya A, Messner HA, Michelis FV. Impact of comorbidities constituting the hematopoietic cell transplant (HCT)-comorbidity index on the outcome of patients undergoing allogeneic HCT for acute myeloid leukemia. Eur J Haematol 2017; 100:198-205. [DOI: 10.1111/ejh.13000] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Manar M. I. Khalil
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Jeffrey H. Lipton
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Eshetu G. Atenafu
- Department of Biostatistics; Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Vikas Gupta
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Dennis D. Kim
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - John Kuruvilla
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Auro Viswabandya
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Hans A. Messner
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Fotios V. Michelis
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
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25
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Hamadani M, Horowitz MM. Allogeneic Transplantation for Follicular Lymphoma: Does One Size Fit All? J Oncol Pract 2017; 13:798-806. [PMID: 29232542 PMCID: PMC5728364 DOI: 10.1200/jop.2017.026336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Follicular lymphoma (FL) exhibits striking biologic and clinical heterogeneity. Patients with newly diagnosed asymptomatic or low-bulk disease may be observed or managed with immunotherapies alone. Chemoimmunotherapy is considered a standard treatment for patients with advanced, symptomatic disease. In patients with FL who achieve at least a partial remission after first-line chemoimmunotherapy, autologous (auto-) hematopoietic cell transplantation (HCT) consolidation is not recommended; however, most patients with FL experience disease relapse after frontline therapies, with the experience of therapy failure within 2 years of first-line treatments predicting poor survival. Despite remarkable efficacy, even in patients who experience failure with other therapies, auto-HCT and allogeneic (allo-) HCT remain underutilized in relapsed/refractory FL, even among healthy and younger patients. Early use of auto-HCT consolidation should be considered a standard therapy option for high-risk patients who experience early failure of chemoimmunotherapy (< 2 years). For patients with FL who experience failure of frontline therapies late (> 2 years), deferring auto-HCT until later in the disease course is reasonable. Allo-HCT is best reserved for medically fit individuals with heavily pretreated disease, persistent marrow involvement, refractory, but low-bulk, disease, and in those who experience a failure to mobilize stem cells for auto-HCT. Allo-HCT is also a reasonable option for patients with FL who experience failure with a prior autograft; lower-intensity conditioning regimens and HLA-matched related donors are preferred in that setting. Future research should focus on the eradication of minimal residual disease before HCT and the prevention of disease relapse after HCT by integrating novel targeted agents into pre-HCT and post-HCT regimens.
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Affiliation(s)
- Mehdi Hamadani
- Medical College of Wisconsin; and Center for International Blood and Marrow Transplant Research, Milwaukee, WI
| | - Mary M. Horowitz
- Medical College of Wisconsin; and Center for International Blood and Marrow Transplant Research, Milwaukee, WI
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26
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Belete H, Burns LJ, Shanley R, Nayar M, McClune B, Lazaryan A, Bachanova V, Bejanyan N, Ustun C, Brunstein C, Weisdorf DJ, Arora M. Transplantation related toxicity and mortality in older autologous hematopoietic cell transplantation recipients. Am J Hematol 2017; 92:E529-E533. [PMID: 28612451 DOI: 10.1002/ajh.24814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 05/26/2017] [Accepted: 06/05/2017] [Indexed: 11/06/2022]
Abstract
With advances in supportive care, autologous hematopoietic cell transplant (AHCT) is increasingly being performed for patients older than 60 years. We analyzed patients receiving an AHCT for multiple myeloma or lymphoma in a contemporary cohort (2010-2012), with consistent treatment and supportive care and compared outcomes [CTCAE grade 3-5 toxicities, nonrelapse mortality (NRM) and overall-survival (OS)] of younger (40-59 years, n = 77) versus older (≥60 years, n = 67) recipients. The proportion of patients with neutropenic infections was higher in the older group (64% vs. 44%; P = 0.02). The proportion of patients with any grade 3-5 toxicity was also higher in the older group (84% vs. 67%, P = 0.03). In multivariate analysis, older age was significantly associated with higher odds (OR: 2.57, 95% CI:1.09-6.05) of grade 3-5 toxicity. The NRM was 3% (older) vs. 0% (younger) at 1 year. The probability of OS at 2 years was lower in the older group (76% vs. 90%, P = 0.04). Though AHCT can be performed safely in older recipients, the higher toxicity and slightly higher NRM in this population needs attention. Studies focusing on risk-stratification in older patients would further help predict toxicity. Further studies addressing enhanced supportive care needs for older patients who are most likely to benefit are indicated.
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Affiliation(s)
- Hewan Belete
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
| | - Linda J. Burns
- Health Services Research, National Marrow Donor Program; Minneapolis Minnesota
| | - Ryan Shanley
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
| | - Manju Nayar
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
| | - Brian McClune
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
| | - Aleksandr Lazaryan
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
| | - Veronika Bachanova
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
| | - Nelli Bejanyan
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
| | - Celalettin Ustun
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
| | - Claudio Brunstein
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
| | - Daniel J. Weisdorf
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
| | - Mukta Arora
- Division of Hematology; University of Minnesota, Oncology and Transplantation; Minneapolis Minnesota 55455
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27
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Potdar R, Varadi G, Fein J, Labopin M, Nagler A, Shouval R. Prognostic Scoring Systems in Allogeneic Hematopoietic Stem Cell Transplantation: Where Do We Stand? Biol Blood Marrow Transplant 2017; 23:1839-1846. [PMID: 28797781 DOI: 10.1016/j.bbmt.2017.07.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/22/2017] [Indexed: 01/19/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation is a potentially curative treatment for many hematologic disorders. Maximizing the benefit of transplantation for disease control while minimizing the risk for associated complications remains the field's leading challenge. This challenge has prompted the development of multiple prognostic scoring systems over the last 2 decades. Prognostic scores can be used for informed decision making, better patient counseling, design of interventional trials, and analysis of prospective and retrospective data. They are also helpful in treatment allocation and personalization according to predicted risk. A better understanding of the molecular and cytogenetic features of the disease, along with the advent of novel therapies, has increased the need for reliable prognostication of which patients will benefit most from transplantation. Here we review the clinical role of the prognostic systems currently in clinical use, examining both their strengths and their limitations.
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Affiliation(s)
- Rashmika Potdar
- Division of Hematology and Oncology, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Gabor Varadi
- Division of Hematology and Oncology, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Joshua Fein
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Myriam Labopin
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France; Acute Leukemia Working Party, EBMT Paris Office, Hôpital Saint-Antoine, Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Acute Leukemia Working Party, EBMT Paris Office, Hôpital Saint-Antoine, Paris, France
| | - Roni Shouval
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat-Gan, Israel.
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28
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Shouval R, Nagler A. From patient centered risk factors to comprehensive prognostic models: a suggested framework for outcome prediction in umbilical cord blood transplantation. Stem Cell Investig 2017; 4:39. [PMID: 28607913 DOI: 10.21037/sci.2017.05.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/10/2017] [Indexed: 12/23/2022]
Abstract
Prospectively identifying patients who will gain maximal benefit from umbilical cord blood transplantation (UCBT) with minimal risk is a desirable unmet need. A complex network of parameters related to patient, disease, donor, and procedure all come into play. We review the prognostic role of patient-related risk factors in adults undergoing UCBT. Furthermore, since comprehensive prognostic models are lacking in UCBT, we suggest a framework for integrating patients' features in the development of prediction models for UCBT outcomes. Such models could contribute to patient selection, optimization of the various modifiable features in the process of UCBT, analysis of retrospective data, and design of interventions.
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Affiliation(s)
- Roni Shouval
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Acute Leukemia Working Party-Paris Office, Hospital Saint-Antoine, EBMT, Paris, France
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29
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Pulmonary Function and Pretransplant Evaluation of the Hematopoietic Cell Transplant Candidate. Clin Chest Med 2017; 38:307-316. [PMID: 28477641 DOI: 10.1016/j.ccm.2016.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pretransplant pulmonary function tests provide baseline data by which to reference subsequent respiratory impairment, as well as important prognostic information, for the hematopoietic cell transplant (HCT) recipient. Abnormalities in forced expiratory volume in 1 second and diffusing capacity of carbon monoxide are associated with early respiratory failure and increased all-cause mortality after allogeneic HCT. These parameters have been incorporated into risk assessment calculators that may aid in clinical decision making. This article discusses the clinical implications of pulmonary function parameters and other risk factors for pulmonary complications in the context of evolving allogeneic HCT practice.
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30
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Beattie S, Lebel S, Petricone-Westwood D, Wilson KG, Harris C, Devins G, Huebsch L, Tay J. Balancing give and take between patients and their spousal caregivers in hematopoietic stem cell transplantation. Psychooncology 2017; 26:2224-2231. [DOI: 10.1002/pon.4340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 11/15/2016] [Accepted: 12/02/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Sara Beattie
- Tom Baker Cancer Centre; Alberta Health Services; Calgary AB Canada
| | - Sophie Lebel
- School of Psychology; University of Ottawa; Ottawa ON Canada
| | | | - Keith G. Wilson
- School of Psychology; University of Ottawa; Ottawa ON Canada
- Department of Psychology; The Ottawa Hospital Rehabilitation Centre; Ottawa ON Canada
- The Ottawa Hospital Research Institute; Ottawa ON Canada
| | - Cheryl Harris
- School of Psychology; University of Ottawa; Ottawa ON Canada
- Department of Psychology; The Ottawa Hospital; Ottawa ON Canada
- The Ottawa Hospital Research Institute; Ottawa ON Canada
| | - Gerald Devins
- Princess Margaret Cancer Centre, University Health Network; Toronto ON Canada
- Ontario Cancer Institute; Toronto ON Canada
- University of Toronto; Toronto ON Canada
| | - Lothar Huebsch
- The Ottawa Hospital Research Institute; Ottawa ON Canada
| | - Jason Tay
- Tom Baker Cancer Centre; Alberta Health Services; Calgary AB Canada
- The Ottawa Hospital Research Institute; Ottawa ON Canada
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31
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Rosko AE, Wang H, de Lima M, Sandmaier B, Khoury HJ, Artz A, Brammer J, Bredeson C, Farag S, Kharfan‐Dabaja M, Lazarus HM, Marks DI, Martino Bufarull R, McGuirk J, Mohty M, Nishihori T, Nivison‐Smith I, Rashidi A, Ringden O, Seftel M, Weisdorf D, Bachanova V, Saber W. Reduced intensity conditioned allograft yields favorable survival for older adults with B-cell acute lymphoblastic leukemia. Am J Hematol 2017; 92:42-49. [PMID: 27712033 DOI: 10.1002/ajh.24575] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 01/14/2023]
Abstract
Older adults with B-cell acute lymphoblastic leukemia (B-ALL) have poor survival. We examined the effectiveness of reduced intensity conditioning (RIC) hematopoietic cell transplant (HCT) in adults with B-ALL age 55 years and older and explored prognostic factors associated with long-term outcomes. Using CIBMTR registry data, we evaluated 273 patients (median age 61, range 55-72) with B-ALL with disease status in CR1 (71%), >CR2 (17%) and Primary Induction Failure (PIF)/Relapse (11%), who underwent RIC HCT between 2001 and 2012 using mostly unrelated donor (59%) or HLA-matched sibling (32%). Among patients with available cytogenetic data, the Philadelphia chromosome (Ph+) was present in 50%. The 3-year cumulative incidences of nonrelapse mortality (NRM) and relapse were 25% (95% confidence intervals (CI): 20-31%) and 47% (95% CI: 41-53%), respectively. Three-year overall survival (OS) was 38% (95% CI: 33-44%). Relapse remained the leading cause of death accounting for 49% of all deaths. In univariate analysis, 3 year risk of NRM was significantly higher with reduced Karnofsky performance status (KPS <90: 34% (95% CI: 25-43%) versus KPS ≥90 (18%; 95% CI: 12-24%, P = 0.006). Mortality was increased in older adults (66+ vs. 55-60: Relative Risk [RR] 1.51 95% CI: 1.00-2.29, P = 0.05) and those with advanced disease (RR 2.13; 95% CI: 1.36-3.34, P = 0.001). Survival of patients in CR1 yields 45% (95% CI: 38-52%) at 3 years and no relapse occurred after 2 years. We report promising OS and acceptable NRM using RIC HCT in older patients with B-ALL. Disease status in CR1 and good performance status are associated with improved outcomes. Am. J. Hematol. 92:42-49, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ashley E. Rosko
- Division of Hematology, Department of MedicineOhio State UniversityColumbus Ohio
| | - Hai‐Lin Wang
- Department of Medicine, Medical College of WisconsinCIBMTR, Center for International Blood and Marrow Transplant ResearchMilwaukee Wisconsin
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer CenterUniversity Hospitals Case Medical CenterCleveland Ohio
| | - Brenda Sandmaier
- Division of Medical OncologyUniversity of Washington and Clinical Research Division, Fred Hutchinson Cancer Research CenterSeattle Washington
| | | | - Andrew Artz
- Section of Hematology/OncologyUniversity of Chicago School of MedicineChicago Illinois
| | | | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research InstituteOttawa Ontario Canada
| | - Sherif Farag
- Indiana University Hospital/Riley Hospital for ChildrenIndianapolis Indianapolis
| | - Mohamed Kharfan‐Dabaja
- Department of Blood and Marrow TransplantationH. Lee Moffit Cancer Center and Research InstituteTampa Florida
| | - Hillard M. Lazarus
- Seidman Cancer CenterUniversity Hospitals Case Medical CenterCleveland Ohio
| | - David I. Marks
- Adult Bone Marrow TransplantUniversity Hospitals Bristol NHS TrustBristol United Kingdom
| | | | | | - Mohamed Mohty
- Hopital Saint‐AntoineAPHP, Universite Pierre & Marie Curie, INSERM UMRs U938Paris France
| | - Taiga Nishihori
- Department of Blood and Marrow TransplantationH. Lee Moffit Cancer Center and Research InstituteTampa Florida
| | | | | | - Olle Ringden
- Division of Therapeutic Immunology, Department of Laboratory MedicineKarolinska InstitutetStockholm Sweden
- Centre for Allogeneic Stem Cell TransplantationStockholm Sweden
| | - Matthew Seftel
- Department of Medical Oncology and HematologyPrincess Margaret Cancer CentreToronto Ontario Canada
| | - Daniel Weisdorf
- Divsion of Hematology, Oncology and Transplantation, Department of MedicineUniversity of Minnesota Medical CenterMinneapolis Minnesota
| | - Veronika Bachanova
- Bone and Marrow Transplant ProgramUniversity of Minnesota Medical CenterMinneapolis Minnesota
| | - Wael Saber
- Department of Medicine, Medical College of WisconsinCIBMTR, Center for International Blood and Marrow Transplant ResearchMilwaukee Wisconsin
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GvHD-free, relapse-free survival after reduced-intensity allogeneic hematopoietic cell transplantation in older patients with myeloid malignancies. Bone Marrow Transplant 2016; 51:1642-1643. [PMID: 27721371 DOI: 10.1038/bmt.2016.254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Fedele R, Salooja N, Martino M. Recommended screening and preventive evaluation practices of adult candidates for hematopoietic stem cell transplantation. Expert Opin Biol Ther 2016; 16:1361-1372. [DOI: 10.1080/14712598.2016.1229773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Ullmann AJ, Schmidt-Hieber M, Bertz H, Heinz WJ, Kiehl M, Krüger W, Mousset S, Neuburger S, Neumann S, Penack O, Silling G, Vehreschild JJ, Einsele H, Maschmeyer G. Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016. Ann Hematol 2016; 95:1435-55. [PMID: 27339055 PMCID: PMC4972852 DOI: 10.1007/s00277-016-2711-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/28/2016] [Indexed: 12/13/2022]
Abstract
Infectious complications after allogeneic haematopoietic stem cell transplantation (allo-HCT) remain a clinical challenge. This is a guideline provided by the AGIHO (Infectious Diseases Working Group) of the DGHO (German Society for Hematology and Medical Oncology). A core group of experts prepared a preliminary guideline, which was discussed, reviewed, and approved by the entire working group. The guideline provides clinical recommendations for the preventive management including prophylactic treatment of viral, bacterial, parasitic, and fungal diseases. The guideline focuses on antimicrobial agents but includes recommendations on the use of vaccinations. This is the updated version of the AGHIO guideline in the field of allogeneic haematopoietic stem cell transplantation utilizing methods according to evidence-based medicine criteria.
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Affiliation(s)
- Andrew J Ullmann
- Department of Internal Medicine II, Division of Hematology and Oncology, Division of Infectious Diseases, Universitätsklinikum, Julius Maximilian's University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Martin Schmidt-Hieber
- Clinic for Hematology, Oncology und Tumor Immunology, Helios Clinic Berlin-Buch, Berlin, Germany
| | - Hartmut Bertz
- Department of Hematology/Oncology, University of Freiburg Medical Center, 79106, Freiburg, Germany
| | - Werner J Heinz
- Department of Internal Medicine II, Division of Hematology and Oncology, Division of Infectious Diseases, Universitätsklinikum, Julius Maximilian's University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Michael Kiehl
- Medical Clinic I, Klinikum Frankfurt (Oder), Frankfurt (Oder), Germany
| | - William Krüger
- Haematology and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Greifswald, Germany
| | - Sabine Mousset
- Medizinische Klinik III, Palliativmedizin und interdisziplinäre Onkologie, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Stefan Neuburger
- Sindelfingen-Böblingen Clinical Centre, Medical Department I, Division of Hematology and Oncology, Klinikverbund Südwest, Sindelfingen, Germany
| | | | - Olaf Penack
- Hematology, Oncology and Tumorimmunology, Charité University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Gerda Silling
- Department of Internal Medicine IV, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, German Centre for Infection Research, Partner-site: Bonn-Cologne, University Hospital of Cologne, Cologne, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, Division of Hematology and Oncology, Division of Infectious Diseases, Universitätsklinikum, Julius Maximilian's University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
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Shouval R, Labopin M, Bondi O, Mishan-Shamay H, Shimoni A, Ciceri F, Esteve J, Giebel S, Gorin NC, Schmid C, Polge E, Aljurf M, Kroger N, Craddock C, Bacigalupo A, Cornelissen JJ, Baron F, Unger R, Nagler A, Mohty M. Prediction of Allogeneic Hematopoietic Stem-Cell Transplantation Mortality 100 Days After Transplantation Using a Machine Learning Algorithm: A European Group for Blood and Marrow Transplantation Acute Leukemia Working Party Retrospective Data Mining Study. J Clin Oncol 2015; 33:3144-51. [DOI: 10.1200/jco.2014.59.1339] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Allogeneic hematopoietic stem-cell transplantation (HSCT) is potentially curative for acute leukemia (AL), but carries considerable risk. Machine learning algorithms, which are part of the data mining (DM) approach, may serve for transplantation-related mortality risk prediction. Patients and Methods This work is a retrospective DM study on a cohort of 28,236 adult HSCT recipients from the AL registry of the European Group for Blood and Marrow Transplantation. The primary objective was prediction of overall mortality (OM) at 100 days after HSCT. Secondary objectives were estimation of nonrelapse mortality, leukemia-free survival, and overall survival at 2 years. Donor, recipient, and procedural characteristics were analyzed. The alternating decision tree machine learning algorithm was applied for model development on 70% of the data set and validated on the remaining data. Results OM prevalence at day 100 was 13.9% (n = 3,936). Of the 20 variables considered, 10 were selected by the model for OM prediction, and several interactions were discovered. By using a logistic transformation function, the crude score was transformed into individual probabilities for 100-day OM (range, 3% to 68%). The model's discrimination for the primary objective performed better than the European Group for Blood and Marrow Transplantation score (area under the receiver operating characteristics curve, 0.701 v 0.646; P < .001). Calibration was excellent. Scores assigned were also predictive of secondary objectives. Conclusion The alternating decision tree model provides a robust tool for risk evaluation of patients with AL before HSCT, and is available online ( http://bioinfo.lnx.biu.ac.il/∼bondi/web1.html ). It is presented as a continuous probabilistic score for the prediction of day 100 OM, extending prediction to 2 years. The DM method has proved useful for clinical prediction in HSCT.
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Affiliation(s)
- Roni Shouval
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Myriam Labopin
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Ori Bondi
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Hila Mishan-Shamay
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Avichai Shimoni
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Fabio Ciceri
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Jordi Esteve
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Sebastian Giebel
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Norbert C. Gorin
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Christoph Schmid
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Emmanuelle Polge
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Mahmoud Aljurf
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Nicolaus Kroger
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Charles Craddock
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Andrea Bacigalupo
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Jan J. Cornelissen
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Frederic Baron
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Ron Unger
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Arnon Nagler
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
| | - Mohamad Mohty
- Roni Shouval, Hila Mishan-Shamay, Avichai Shimoni, and Arnon Nagler, The Chaim Sheba Medical Center, Tel-Hashomer; Roni Shouval, Ori Bondi, and Ron Unger, Bar-Ilan University, Ramat-Gan, Israel; Myriam Labopin, Norbert C. Gorin, Emmanuelle Polge, Arnon Nagler, and Mohamad Mohty, European Group for Blood and Marrow Transplantation; Myriam Labopin and Mohamad Mohty, Sorbonne Universités, Centre de Recherche (CDR) Saint-Antoine; Myriam Labopin and Mohamad Mohty, Institut National de la Santé et de la
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Virmani P, Zain J, Rosen ST, Myskowski PL, Querfeld C. Hematopoietic Stem Cell Transplant for Mycosis Fungoides and Sézary Syndrome. Dermatol Clin 2015; 33:807-18. [DOI: 10.1016/j.det.2015.05.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Hamilton BK, Law AD, Rybicki L, Abounader D, Dabney J, Dean R, Duong HK, Gerds AT, Hanna R, Hill BT, Jagadeesh D, Kalaycio ME, Lawrence C, McLellan L, Pohlman B, Sobecks RM, Bolwell BJ, Majhail NS. Prognostic significance of pre-transplant quality of life in allogeneic hematopoietic cell transplantation recipients. Bone Marrow Transplant 2015; 50:1235-40. [PMID: 26030045 DOI: 10.1038/bmt.2015.122] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/25/2015] [Accepted: 04/05/2015] [Indexed: 11/09/2022]
Abstract
Quality of life (QOL) is an important outcome for hematopoietic cell transplantation (HCT) recipients. Whether pre-HCT QOL adds prognostic information to patient and disease related risk factors has not been well described. We investigated the association of pre-HCT QOL with relapse, non-relapse mortality (NRM), and overall mortality after allogeneic HCT. From 2003 to 2012, the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale instrument was administered before transplantation to 409 first allogeneic HCT recipients. We examined the association of the three outcomes with (1) individual QOL domains, (2) trial outcome index (TOI) and (3) total score. In multivariable models with individual domains, functional well-being (hazard ratio (HR) 0.95, P=0.025) and additional concerns (HR 1.39, P=0.002) were associated with reduced risk of relapse, no domain was associated with NRM, and better physical well-being was associated with reduced risk of overall mortality (HR 0.97, P=0.04). TOI was not associated with relapse or NRM but was associated with reduced risk of overall mortality (HR 0.93, P=0.05). Total score was not associated with any of the three outcomes. HCT-comorbidity index score was prognostic for greater risk of relapse and mortality but not NRM. QOL assessments, particularly physical functioning and functional well-being, may provide independent prognostic information beyond standard clinical measures in allogeneic HCT recipients.
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Affiliation(s)
- B K Hamilton
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - A D Law
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - L Rybicki
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - D Abounader
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - J Dabney
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - R Dean
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - H K Duong
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - A T Gerds
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - R Hanna
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - B T Hill
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - D Jagadeesh
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - M E Kalaycio
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - C Lawrence
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - L McLellan
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - B Pohlman
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - R M Sobecks
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - B J Bolwell
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - N S Majhail
- Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
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Allareddy V, Venugopalan SR, Eswaran SVK, Rampa S, Anamali S, Nalliah RP, Shin K, Allareddy V, Elangovan S. Important impact of gingival and periodontal conditions on outcomes in SCT recipients. Bone Marrow Transplant 2015; 50:604-6. [PMID: 25599170 DOI: 10.1038/bmt.2014.311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- V Allareddy
- Department of Orthodontics, College of Dentistry - The University of Iowa, Iowa City, IA, USA
| | - S R Venugopalan
- Department of Orthodontics and Dentofacial Orthopedics, University of Missouri - Kansas City, Kansas City, MO, USA
| | - S V K Eswaran
- Department of Periodontics, The University of Texas at Houston, Houston, TX, USA
| | - S Rampa
- Department of Health Management and Policy, College of Public Health - University of Nebraska Medical Center, Omaha, NE, USA
| | - S Anamali
- Department of Preventive Dentistry - College of Dentistry, The University of Iowa, Iowa City, IA, USA
| | - R P Nalliah
- Office of Global Health, Harvard School of Dental Medicine, Boston, MA, USA
| | - K Shin
- Department of Orthodontics, College of Dentistry - The University of Iowa, Iowa City, IA, USA
| | | | - S Elangovan
- Department of Periodontics, College of Dentistry - The University of Iowa, Iowa City, IA, USA
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Wildes TM, Rosko A, Tuchman SA. Multiple myeloma in the older adult: better prospects, more challenges. J Clin Oncol 2014; 32:2531-40. [PMID: 25071143 DOI: 10.1200/jco.2014.55.1028] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Multiple myeloma (MM) is disproportionately diagnosed in older adults; with the aging of the population, the number of older adults diagnosed with MM will increase by nearly 80% in the next two decades. Duration of survival has improved dramatically over the last 20 years, but the improvements in older adults have not been as great as those in younger adults with MM. METHODS In this article, we address treatment approaches in older adults who are eligible for and those ineligible for high-dose therapy with autologous stem-cell transplantation as well as supportive care considerations and the potential role for geriatric assessment in facilitating decision making for older adults with MM. RESULTS The evidence from recent studies demonstrates that combinations of novel and conventional antimyeloma agents result in improved response rates and, in some cases, improved progression-free and overall survival. However, some older adults are particularly vulnerable to toxicities of therapy and discontinuation of therapy and, consequently, they have poorer survival. In addition, older adults may prioritize other outcomes of therapy, such as quality of life, over more conventional end points such as disease response and duration of survival. Geriatric assessment can facilitate risk-stratification of older adults at greater risk for adverse events from therapy and aid in personalizing therapy for vulnerable or frail older adults. CONCLUSION Survival in older adults with MM is improving with novel therapeutics, but efficacy must be balanced with risk of toxicity of therapy and maintenance of quality of life. Novel instruments such as geriatric assessment tools may facilitate these aims.
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Laskin BL, Nehus E, Goebel J, Furth S, Davies SM, Jodele S. Estimated versus measured glomerular filtration rate in children before hematopoietic cell transplantation. Biol Blood Marrow Transplant 2014; 20:2056-61. [PMID: 25038395 PMCID: PMC4252845 DOI: 10.1016/j.bbmt.2014.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/06/2014] [Indexed: 11/23/2022]
Abstract
An accurate assessment of kidney function before hematopoietic cell transplantation (HCT) can help to properly dose conditioning chemotherapy and follow patients for the development of chronic kidney disease. We cross-sectionally examined 94 children and young adults before HCT to compare formal nuclear glomerular filtration rate (GFR) testing with estimated GFR using creatinine and cystatin C-based equations, including the original Schwartz formula and the more recent formulas developed in the Chronic Kidney Disease in Children (CKiD) cohort. The median age of the cohort was 5.9 years (range, .26 to 30.5 years). The mean cohort nuclear GFR was 107.4 ± 24.7 mL/min/1.73 m(2), with 18 of 94 subjects (19.1%) having abnormal kidney function (GFR < 90 mL/min/1.73 m(2)) before HCT. The creatinine-based original Schwartz and bedside CKiD formulas showed significant bias, overestimating the nuclear GFR by 57.4 (95% confidence interval [CI], 49.0 to 65.8) and 14.1 (95% CI, 7.1 to 21.1) mL/min/1.73 m(2), respectively. Cystatin C formulas had less mean bias and improved accuracy but also had decreased sensitivity to detect abnormal kidney function before HCT. The Full CKiD equation showed the best performance, with a mean bias of -3.6 mL/min/1.73 m(2) (95% CI, -8.4 to 1.2) that was not significantly different from the measured value and 87.7% of estimates within ±30% of the nuclear GFR. Although the more recent bedside CKiD formula performed better than the original Schwartz formula, both formulas had poor sensitivity for detecting a low GFR. An abnormal pretransplant nuclear GFR was not associated with post-HCT acute kidney injury, the need for dialysis, or death in the first 100 days. In conclusion, we observed cystatin C-based equations outperformed creatinine-based equations in estimating GFR in children before HCT. However, all formulas had decreased sensitivity to detect impaired GFR. Formal measurement of kidney function should be considered in children and young adults who need an accurate assessment of kidney function before HCT.
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Affiliation(s)
- Benjamin L Laskin
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Edward Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jens Goebel
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Susan Furth
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stella M Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sonata Jodele
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Abstract
High-dose chemotherapy followed by transplantation of autologous hematopoietic progenitor cells has a proven track record of safety and efficacy in hematological malignancies and select solid tumors. The near-universal use of peripheral blood stem cells as source for autografts, routine growth factor support, and antimicrobial prophylaxis post transplantation has improved the safety of this procedure. However, the advent of highly active novel therapies in the last few years warrants reappraisal of the role of autologous transplantation in the therapeutic armamentarium of malignant disorder. This review summarizes the current role of autologous transplantation for hematological malignancies, discusses modern standards for patient selection, and highlights long-term care issues of transplant survivors from an internist's perspective. Role of tumor purging in autologous transplantation, novel transplant conditioning regimens, and post-transplant therapies to prevent disease relapse are reviewed.
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Affiliation(s)
- Mehdi Hamadani
- Division of Hematology & Oncology, Medical College of Wisconsin , Milwaukee, WI , USA
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42
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[Current indications of allogeneic stem cell transplant in adults with acute myeloid leukemia]. Bull Cancer 2014; 101:856-65. [PMID: 25296413 DOI: 10.1684/bdc.2014.1944] [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] [Indexed: 01/02/2023]
Abstract
Allogeneic stem cell transplantation (SCT) is an increasingly important therapeutic option for the treatment of adult patients with acute myeloid leukemia. Here we review the current indications of SCT in this disease. While patients with favorable cytogenetics should receive consolidation chemotherapy, patients with unfavorable karyotype are prime candidates for SCT or new approaches to SCT (which should be done in first complete remission). Patients with intermediate prognoses should also receive SCT in first complete remission. In the absence of a suitable matched related donor, most patients will be able to find an alternative donor to proceed to a potentially curative allogeneic transplantation. The use of reduced-intensity conditioning regimens before SCT has allowed patients in the sixth or seventh decades of life to be routinely transplanted. Despite major differences among transplant centers in the intensity and composition of the conditioning regimen and immunosuppression, choice of graft source, postgraft immune-modulation, and supportive care, there has been a dramatic improvement in terms of tolerance. Although it is presumed to be a curative strategy, major complications of SCT remain graft-versus-host disease, delayed immune recovery, multiple comorbidities, and relapse after transplant.
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Gerull S, Medinger M, Heim D, Passweg J, Stern M. Evaluation of the pretransplantation workup before allogeneic transplantation. Biol Blood Marrow Transplant 2014; 20:1852-6. [PMID: 24979730 DOI: 10.1016/j.bbmt.2014.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/21/2014] [Indexed: 01/09/2023]
Abstract
An extensive workup is generally performed before allogeneic transplantation. The extent of this workup varies substantially between centers because of a lack of guidelines. We analyzed 157 consecutive allogeneic transplant candidates to understand the significance of components of the pretransplant evaluation. Workup consisted of chest computed tomography (CT); magnetic resonance imaging of the head; dental, ears-nose-throat (ENT), ophthalmology, and gynecology evaluations; pulmonary function tests; echocardiography; cytomegalovirus PCR; urine culture; clinical evaluation; and disease staging. Results were categorized as "normal or minor finding" or "major finding" (having significant consequences such as further testing or therapy). Major findings were classified as incidental or related to history and symptoms. Components of the pretransplant workup with the highest rate of major findings were CT (22%), dental evaluation (13%), and ENT (12%, mostly symptomatic). All other components had a low rate of major findings. Although 126 transplants were performed as scheduled, 24 were delayed and 7 canceled at short notice. The main reasons for delaying or canceling transplantation were active infection and unexpected disease progression. A prospective evaluation of a more restricted, symptom-guided pretransplant evaluation appears to be warranted.
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Affiliation(s)
- Sabine Gerull
- Division of Hematology, University Hospital Basel, Basel, Switzerland.
| | - Michael Medinger
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Dominik Heim
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Jakob Passweg
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Martin Stern
- Division of Hematology, University Hospital Basel, Basel, Switzerland
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Michaelis LC, Hamadani M, Hari PN. Hematopoietic stem cell transplantation in older persons: respecting the heterogeneity of age. Expert Rev Hematol 2014; 7:321-4. [PMID: 24785114 DOI: 10.1586/17474086.2014.913978] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Demographic trends establish that older adults are the fastest growing segment of population, with over 19% of the population expected to be aged >65 years by 2030. As the risk for hematologic malignancies increases with age, it is imperative that our field continues to strive to individualize and manage risk and benefit in an aging population. While hematologic diseases are more common in the elderly, only a small minority of patients with hematological malignancy aged >65 years receive allogeneic hematopoietic cell transplantation, relative to the burden of disease in this population. In this editorial we explore some of the obstacles to transplantation, the rationale to consider the procedure in the older adult and ways that the stem cell consultative process can be individualized. Finally, we outline key areas where additional research is needed.
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Affiliation(s)
- Laura C Michaelis
- Hematologic Malignancies Program, Division of Hematology/Oncology, Medical College of Wisconsin, Froedtert Hospital, Milwaukee, WI, USA
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Kanate AS, Pasquini MC, Hari PN, Hamadani M. Allogeneic hematopoietic cell transplant for acute myeloid leukemia: Current state in 2013 and future directions. World J Stem Cells 2014; 6:69-81. [PMID: 24772235 PMCID: PMC3999783 DOI: 10.4252/wjsc.v6.i2.69] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/03/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
Acute myeloid leukemia (AML) represents a heterogeneous group of high-grade myeloid neoplasms of the elderly with variable outcomes. Though remission-induction is an important first step in the management of AML, additional treatment strategies are essential to ensure long-term disease-free survival. Recent pivotal advances in understanding the genetics and molecular biology of AML have allowed for a risk-adapted approach in its management based on relapse-risk. Allogeneic hematopoietic cell transplantation (allo-HCT) represents an effective therapeutic strategy in AML providing the possibility of cure with potent graft-versus-leukemia reactions, with a demonstrable survival advantage in younger patients with intermediate- or poor-risk cytogenetics. Herein we review the published data regarding the role of allo-HCT in adults with AML. We searched MEDLINE/PubMed and EMBASE/Ovid. In addition, we searched reference lists of relevant articles, conference proceedings and ongoing trial databases. We discuss the role of allo-HCT in AML patients stratified by cytogenetic- and molecular-risk in first complete remission, as well as allo-HCT as an option in relapsed/refractory AML. Besides the conventional sibling and unrelated donor allografts, we review the available data and recent advances for alternative donor sources such as haploidentical grafts and umbilical cord blood. We also discuss conditioning regimens, including reduced intensity conditioning which has broadened the applicability of allo-HCT. Finally we explore recent advances and future possibilities and directions of allo-HCT in AML. Practical therapeutic recommendations have been made where possible based on available data and expert opinion.
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Validation of the EBMT Risk Score for South Brazilian Patients Submitted to Allogeneic Hematopoietic Stem Cell Transplantation. BONE MARROW RESEARCH 2013; 2013:565824. [PMID: 24416593 PMCID: PMC3876681 DOI: 10.1155/2013/565824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/04/2013] [Accepted: 11/06/2013] [Indexed: 01/26/2023]
Abstract
Background. Allogeneic hematopoietic stem cell transplantation (HSCT) is still associated with a high transplant-related mortality rate. In 2009, the EBMT risk score was validated as a simple tool to predict the outcome after allogeneic HSCT for acquired hematological disorders. Objectives. The aim of this study was to validate the applicability of the EBMT risk score for allogeneic HSCT on South Brazilian patients. Methods. A retrospective observational study was performed based on patients' records and data base at Hospital de Clínicas de Porto Alegre, including all allogeneic transplants for malignant and severe aplastic anemia from 1994 to 2010. Patients were categorized according to EBMT risk score and overall survival (OS). Nonrelapse mortality (NRM) and relapse rate (RR) were analyzed. Results. There were 278 evaluable patients. OS, NRM, and RR at five years median followup were 48.7%, 40.7%, and 30.7%, respectively. The OS was 81.8% for risk score 0 and 0% for score 6 (P < 0.001), and NRM was 13.6% and 80% for risk scores 0 and 6, respectively (P = 0.001). Conclusion. The EBMT risk score can be utilized as a tool for clinical decision making before allogeneic HSCT for malignant hematological diseases and severe aplastic anemia at a single center in Brazil.
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Application of machine learning algorithms for clinical predictive modeling: a data-mining approach in SCT. Bone Marrow Transplant 2013; 49:332-7. [DOI: 10.1038/bmt.2013.146] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 01/18/2023]
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48
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Controversies and recent advances in hematopoietic cell transplantation for follicular non-hodgkin lymphoma. BONE MARROW RESEARCH 2012; 2012:897215. [PMID: 23097707 PMCID: PMC3477524 DOI: 10.1155/2012/897215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 11/17/2022]
Abstract
Commonly designated as an indolent non-Hodgkin lymphoma, follicular lymphoma (FL) presents with striking pathobiological and clinical heterogeneity. Initial management strategies for FL have evolved to involve combination chemoimmunotherapy and/or radio-immunoconjugates. Unfortunately even with the best available nontransplant treatment, which nowadays results in higher frequency of response, FL remains incurable. Although considered a feasible therapeutic option, the use of hematopoietic cell transplantation (HCT) remains controversial. The appropriate timing, graft source, and intensity of HCT conditioning regimens in FL are often matters of debate. Herein we review the available published data pertaining to the use of autologous or allogeneic HCT in patients with FL across different stages of the disease, discuss major recent advances in the field, and highlight avenues for future research. The current literature does not support a role of HCT for FL in first remission, but in the relapsed setting autologous HCT remains appropriate for patients with early chemosensitive relapses, while allogeneic transplantation remains the sole curative modality for this disease, in relatively younger patients without significant comorbidities.
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49
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Reappraising the role of autologous transplantation for indolent B-cell lymphomas in the chemoimmunotherapy era: is it still relevant? Bone Marrow Transplant 2012; 48:1013-21. [PMID: 23000653 DOI: 10.1038/bmt.2012.182] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 08/22/2012] [Indexed: 12/28/2022]
Abstract
The role of autologous hematopoietic cell transplantation (auto-HCT) in the management of indolent non-Hodgkin lymphomas (NHL) is shrouded in controversy. The outcomes of conventional therapies for many indolent lymphoma subtypes have dramatically improved over the last several years with the use of monoclonal antibodies, maintenance therapy programs and with the incorporation of radio-immunoconjugates. These significant advances in the armamentarium of lymphoma therapeutics warrant reappraisal of the current role of auto-HCT in the treatment algorithm of indolent NHL. Prospective randomized studies comparing contemporary chemoimmunotherapies against auto-HCT are lacking, leading to significant debate about the role and timing of auto-HCT for indolent NHL in the modern era. Although autografting for follicular lymphoma (FL) in first remission has been largely abandoned, it remains a useful modality for relapsed disease, especially for the subgroup of patients who are not candidates for allogeneic transplantation with a curative intent. Auto-HCT can provide durable disease control in chemosensitive transformed FL and mantle cell lymphoma (MCL) in first remission, with relatively low toxicity, and remains appropriate in chemoimmunotherapy era. Contemporary data are also reviewed to clarify the often underutilized role of autografting in relapsed MCL and other less frequent indolent NHL histologies. The biological basis of the increased risks of second malignancies with auto-HCT are reviewed to identify strategies designed to mitigate this risk by, for example, avoiding exposure to genotoxic agents, planning early stem cell collection/cryopreservation and minimizing the use of TBI with transplant conditioning, and so on. Genetic testing able to identify patients at high risk of therapy-related complications and novel post-transplant immune therapies with the potential of transforming autografting in indolent NHL from a remission-extending therapy to a curative modality are discussed to examine the possibly expanding role of auto-HCT for lymphoid malignancies in the coming years.
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50
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Applebaum AJ, DuHamel KN, Winkel G, Rini C, Greene PB, Mosher CE, Redd WH. Therapeutic alliance in telephone-administered cognitive-behavioral therapy for hematopoietic stem cell transplant survivors. J Consult Clin Psychol 2012; 80:811-6. [PMID: 22468908 DOI: 10.1037/a0027956] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A strong therapeutic alliance has been found to predict psychotherapeutic treatment success across a variety of therapeutic modalities and patient populations. However, only a few studies have examined therapeutic alliance as a predictor of psychotherapy outcome among cancer survivors, and none have examined this relation in telephone-administered cognitive-behavioral therapy (T-CBT). This study evaluated the extent to which therapeutic alliance affected psychotherapy outcomes in survivors of hematopoietic stem cell transplantation (HSCT), a treatment for some cancers. METHOD Forty-six patients enrolled in a randomized clinical trial of T-CBT for posttraumatic stress disorder (PTSD) completed a baseline assessment (including self-report measures of PTSD symptoms, depression, and general distress), 10 individual T-CBT sessions, and follow-up assessments at 6, 9, and 12 months post-baseline. Therapeutic alliance was assessed after the 3rd T-CBT session with the Working Alliance Inventory, which yields overall and subscale (task, bond, and goal) scores. RESULTS Analyses revealed that higher total therapeutic alliance scores prospectively predicted decreased depressive symptomatology; higher task scores predicted decreased overall distress, depressive symptomatology, symptoms of re-experiencing, and avoidance; and higher bond scores predicted decreased depressive symptomatology and symptoms of re-experiencing. CONCLUSIONS These results suggest that assessments of therapeutic alliance should be incorporated into routine clinical care, and therapeutic alliance should be specifically cultivated in interventions to maximize psychotherapeutic benefits involving vulnerable populations such as cancer survivors.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave., New York, NY 10022, USA.
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