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Stuver R, Mian A, Brown S, Devlin S, Caimi PF, Chinapen S, Dahi P, Dean R, Epstein-Peterson ZD, Hill B, Horwitz SM, Lahoud O, Lin R, Moskowitz AJ, Sauter C, Shah G, Winter A, Jagadeesh D, Scordo M. BEAM versus pharmacokinetics-directed BuCyVP16 conditioning for patients with peripheral T-cell lymphoma undergoing high-dose therapy with autologous hematopoietic cell transplantation. Am J Hematol 2024; 99:1180-1183. [PMID: 38526002 PMCID: PMC11096040 DOI: 10.1002/ajh.27291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Robert Stuver
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Agrima Mian
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Samantha Brown
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Sean Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Paolo F. Caimi
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Stephanie Chinapen
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
| | - Parastoo Dahi
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Robert Dean
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | | | - Brian Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Steven M. Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Oscar Lahoud
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Richard Lin
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Alison J. Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Craig Sauter
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Gunjan Shah
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Alison Winter
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Michael Scordo
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
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2
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Zeng Q, Zhang H, Kuang P, Li J, Chen X, Dong T, Wu Q, Zhang C, Chen C, Niu T, Liu T, Liu Z, Ji J. A novel conditioning regimen of chidamide, cladribine, gemcitabine, and busulfan in the autologous stem cell transplantation of aggressive T-cell lymphoma. Front Oncol 2023; 13:1143556. [PMID: 36969020 PMCID: PMC10034030 DOI: 10.3389/fonc.2023.1143556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundThe prognosis of patients with peripheral T-cell (PTCL) or lymphoblastic T-cell lymphoma (T-LBL) remains poor under current conditioning regimens before receiving autologous stem cell transplantation (ASCT).MethodsPatients with PTCL or T-LBL were enrolled to receive ASCT using the conditioning regimen of chidamide, cladribine, gemcitabine, and busulfan (ChiCGB). Positron emission tomography-computed tomography (PET/CT) was used to evaluate the response to ASCT. Overall survival (OS) and progression-free survival (PFS) were employed to assess the patient outcome, and adverse events were used to assess the regimen’s safety. The survival curve was estimated via the Kaplan-Meier method.ResultsTwenty-five PTCL and 11 T-LBL patients were recruited. The median time to neutrophile and platelet engraftments was 10 days (8–13 days) and 13 days (9–31 days), respectively. The 3-year PFS and OS were 81.3 ± 7.2% and 88.5 ± 5.4% for all patients; 92.0 ± 5.4% and 81.2 ± 8.8% for PTCL patients; and both 81.8 ± 11.6% for T-LBL patients, respectively. The 3-year PFS and OS were both 92.9 ± 4.9% for patients with complete response (CR) but 50.0 ± 17.7% and 75.0 ± 15.3% for patients with non-CR, respectively. Infection was the most common non-hematological toxicity, and all toxicities were mild and controllable.ConclusionsChiCGB was a potentially effective and well-tolerated conditioning regimen to improve the prognosis of patients with aggressive T-cell lymphoma. Future randomized controlled trials are needed to assess ChiCGB as a conditioning regimen for ASCT.
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Affiliation(s)
- Qiang Zeng
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Zhang
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Pu Kuang
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinchuan Chen
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Tian Dong
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuhui Wu
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
- Stem Cell Transplantation and Cellular Therapy Division, Clinic Trial Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanli Zhang
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Chunping Chen
- Department of Hematology, West China Hospital/Shangjin Nanfu Hospital, Chengdu, China
| | - Ting Niu
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Liu
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhigang Liu
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
- Stem Cell Transplantation and Cellular Therapy Division, Clinic Trial Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Zhigang Liu, ; Jie Ji,
| | - Jie Ji
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
- Stem Cell Transplantation and Cellular Therapy Division, Clinic Trial Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Zhigang Liu, ; Jie Ji,
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3
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Gunes AK, Serin I, Demir I, Sarifakiogullari S, Durusoy SS, Akkurt DM, Ince I, Ozkan G, Cinli TA, Pehlivan M. Comparison of Mitoxantrone-Melphalan and BEAM Conditioning Regimens in Patients with Lymphoma. Hematol Oncol Stem Cell Ther 2022; 15:201-207. [PMID: 33933474 DOI: 10.1016/j.hemonc.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/20/2021] [Accepted: 03/27/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE/BACKGROUND Lymphoma is seen as a highly treatable and curable malignancy with aggressive treatment methods. Efficacy is often limited by toxicity and many patients need alternative treatment strategies as they cannot tolerate existing high cytotoxic approaches. Our aim is to compare BEAM [carmustine (BCNU), etoposide, cytarabine (ARA-C, cytosine arabinoside), and melphalan] and mitoxantrone-melphalan (Mx-Mel) regimens utilized in our patients with a diagnosis of lymphoma who underwent autologous stem cell transplantation (ASCT), and to demonstrate that the Mx-Mel regimen has similar but less toxic results than the BEAM regimen we have been using frequently as standard conditioning regimen. METHODS A total of 101 patients with lymphoma who underwent ASCT were included in our study. The BEAM regimen included BCNU, etoposide, ARA-C, and melphalan. The Mx-Mel regimen included mitoxantrone and melphalan. RESULTS Of 101 patients included in the study, 60 (59.4%) received BEAM and 41 (40.6%) received Mx-Mel (40.6%) conditioning regimen. The median time to neutrophil engraftment was 10 (range: 9-20) days and 12 (range: 9-12) days in the BEAM and Mx-Mel arms, respectively; it was statistically significantly shorter in the BEAM arm (p = .001). CONCLUSION This study demonstrates that the Mx-Mel regimen has similar efficacy and toxicity compared with the BEAM regimen. Although time to neutrophil engraftment was shorter in the BEAM arm, it did not result as significant transplant-related complications between the two regimens. The Mx-Mel regimen is seen as a good alternative with low toxicity and high efficacy.
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Affiliation(s)
| | - Istemi Serin
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Hematology, Istanbul, Turkey
| | - Ilknur Demir
- Gaziantep Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | | | | | - Dervis Murad Akkurt
- Gaziantep University, Faculty of Medicine, Department of Hematology, Gaziantep, Turkey
| | - Idris Ince
- Dr. Ersin Aslan Training and Research Hospital, Department of Hematology, Gaziantep, Turkey
| | - Gulkan Ozkan
- Istanbul Hamidiye Sisli Etfal Training and Research Hospital, Department of Hematology, Istanbul, Turkey
| | - Tahir Alper Cinli
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Hematology, Istanbul, Turkey
| | - Mustafa Pehlivan
- Gaziantep University, Faculty of Medicine, Department of Hematology, Gaziantep, Turkey
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4
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Ji J, Liu Z, Kuang P, Dong T, Chen X, Li J, Zhang C, Liu J, Zhang L, Shen K, Liu T. A new conditioning regimen with chidamide, cladribine, gemcitabine and busulfan significantly improve the outcome of high-risk or relapsed/refractory non-Hodgkin's lymphomas. Int J Cancer 2021; 149:2075-2082. [PMID: 34398971 DOI: 10.1002/ijc.33761] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 02/05/2023]
Abstract
Previous studies highlight the need for a more active conditioning therapy in high-risk or refractory and relapsed lymphomas. Our preclinical research shows that histone deacetylase inhibitors, such as either vorinostat or chidamide, sensitize lymphoma cells to the cytotoxic combination of cladribine, gemcitabine and busulfan, leading to cell apoptosis. To evaluate the efficacy of this chidamide-cladribine-gemcitabine-busulfan (ChiCGB) combination as a new conditioning therapy, we conducted a Phase II trial, as described here. Patients with high-risk, relapsed/refractory lymphomas received ChiCGB as conditioning therapy, after transplantation with autologous peripheral stem cells. The sample comprised 105 patients in total: 60 with B-cell non-Hodgkin lymphomas (B-NHL) and 45 with T-cell or natural killer/T-cell lymphoma (NK/T). All patients eventually achieved full hematopoietic recovery. Neutrophils and platelets were engrafted at a median of 10 days (8-14) and 13 days (8-38), respectively. There was no transplant-related mortality within 100 days of transplant. Neutropenic fever, mucositis and atopic dermatitis were the observed nonhematologic toxicities. At a median follow-up of 35.4 months, 80.6% of the patients presented with no tumor progression, and the overall survival (OS) reached as high as 86.1%. Concerning the OS rate, 94.5% of patients with B-NHL and 75.4% of patients with T-cell or NK/T lymphomas survived. These findings demonstrate the safety and validity of the proposed combined therapy for high-risk and refractory/relapsed lymphomas. Our study was registered on the Clinical Trial Registry (clinicaltrials.gov, NCT03151876).
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Affiliation(s)
- Jie Ji
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhigang Liu
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Pu Kuang
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Tian Dong
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Xinchuan Chen
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Jian Li
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Chuanli Zhang
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Jiazhuo Liu
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Li Zhang
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Kai Shen
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Ting Liu
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, China
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5
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Ron-Magaña AL, Fernandez-Vargas OE, Barrera-Chairez E, Ron-Guerrero CS, Bañuelos-Ávila AJ. BEAM-Modified Conditioning Therapy with Cisplatin+Dexamethasone Instead of Carmustine Prior to Autologous Hematopoietic Stem Cell Transplantation (HSCT) in Patients with Hodgkin and Non-Hodgkin Lymphoma. Ann Transplant 2019; 24:584-587. [PMID: 31636248 PMCID: PMC6824191 DOI: 10.12659/aot.918259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background High-dose chemotherapy followed by autologous hematopoietic stem cell transplant has proven useful in relapsed or refractory cases of Hodgkin and non-Hodgkin lymphoma. BEAM (carmustine, etoposide, cytarabine, melphalan) is frequently used as a conditioning regimen; however, the high cost and limited availability of BCNU hinders its use in Mexico. Material/Methods Between January 2013 and February 2019, refractory or relapsing HL and NHL patients were treated with an autologous HSCT conditioned with cisplatin+dexamethasone as substitution for BCNU in BEAM. Results Four HL patients and 6 NHL patients were included; 60% were male, the average age was 34.5±15.2 years, the median follow-up was 19.1 months, and 70% had a complete response after transplant. OS at 12 months was 63% for NHL and 100% for HL. Time to hematological recovery was 17.6±2.8 days; all patients developed grade III/IV neutropenia and thrombocytopenia, and 8 patients had transplant-related infections. Conclusions This retrospective study based on real-world data introduces the option of substituting carmustine with cisplatin+dexamethasone, with a similar response, expected lower cost, and better accessibility in developing nations.
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Affiliation(s)
- Ana Lucia Ron-Magaña
- Hemapoietic Stem Cell Transplantation Unit, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.,Department of Hematology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - Omar Eduardo Fernandez-Vargas
- Department of Hematology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.,Department of Physiology, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Esperanza Barrera-Chairez
- Department of Hematology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.,Department of Physiology, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | | | - Ana Jaqueline Bañuelos-Ávila
- Hemapoietic Stem Cell Transplantation Unit, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
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6
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Hill BT, Rybicki LA, Urban TA, Lucena M, Jagadeesh D, Gerds AT, Dean RM, Sobecks RM, Pohlman B, Bolwell B, Kalaycio ME, Hamilton BK, Copelan EA, Majhail NS. Therapeutic Dose Monitoring of Busulfan Is Associated with Reduced Risk of Relapse in Non-Hodgkin Lymphoma Patients Undergoing Autologous Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 26:262-271. [PMID: 31610237 DOI: 10.1016/j.bbmt.2019.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/10/2019] [Accepted: 09/28/2019] [Indexed: 11/28/2022]
Abstract
Optimal administration of busulfan (Bu) is hampered by variable and unpredictable drug metabolism in individual patients. At our institution, Bu was previously administered with fixed weight-based dosing (WBD) in combination with cyclophosphamide (Cy) and etoposide (E) for patients with non-Hodgkin lymphoma (NHL) undergoing autologous stem cell transplantation (ASCT). In 2014, we adopted real-time pharmacokinetic (PK)-guided therapeutic drug monitoring (TDM) of Bu for all NHL patients undergoing Bu-containing ASCT. Here we compare outcomes of NHL patients who underwent ASCT with Bu/Cy/E using WBD and those who did so using TDM of Bu. We studied 336 consecutive adult NHL patients who underwent ASCT with Bu/Cy/E using WBD from January 2007 to December 2013 (n = 258) or TDM from May 2014 to December 2017 (n = 78), excluding patients with mantle cell lymphoma. Clinical outcomes, including relapse, nonrelapse mortality (NRM), progression-free survival (PFS), and overall survival (OS), hepatotoxicity and pulmonary toxicity were compared in the 2 groups. To adjust for differences in baseline characteristics between the groups, propensity-matched cohorts of WBD and TDM patients were also studied. After the first dose of Bu, the dose was increased in 36% of the patients and decreased in 41%. Changes in pulmonary and liver function from baseline to transplantation were not different between the 2 groups, although these changes showed significantly less variability with TDM than with WBD. Relapse was significantly lower and PFS was improved with TDM; 2-year estimates were 19% for TDM and 38% for WBD for relapse (P = .004) and 69% and 55%, respectively, for PFS (P = .038). No significant between-group differences in NRM or OS were seen. In multivariable analysis, TDM remained prognostic for lower risk of relapse (hazard ratio [HR], .52; 95% confidence interval [CI], .30 to .89; P = .018), but did not remain prognostic for PFS (HR, .74; 95% CI, .48 to 1.16; P = .19). Propensity-matched cohorts displayed similar patterns of outcomes. In subset analysis based on disease status at ASCT, TDM was associated with less relapse and better PFS than WBD for patients who underwent transplantation in less than complete remission (CR) compared with those who underwent transplantation in CR. Compared with WBD, PK-directed TDM of Bu reduces the incidence of relapse when used in combination with Cy and E for patients with NHL undergoing ASCT, particularly for patients in less than CR. These data support the continued use of personalized PK-guided dosing for all NHL patients undergoing ASCT with Bu-containing preparative regimens.
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Affiliation(s)
- Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina.
| | - Lisa A Rybicki
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina
| | | | - Mariana Lucena
- Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina
| | - Aaron T Gerds
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina
| | - Robert M Dean
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina
| | - Ronald M Sobecks
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina
| | - Brad Pohlman
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina
| | - Brian Bolwell
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina
| | - Matt E Kalaycio
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina
| | - Betty K Hamilton
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina
| | - Edward A Copelan
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; Levine Cancer Institute, Charlotte, North Carolina
| | - Navneet S Majhail
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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