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Gibson CJ, Lindsley RC, Gondek LP. Clonal hematopoiesis in the setting of hematopoietic cell transplantation. Semin Hematol 2024; 61:9-15. [PMID: 38429201 PMCID: PMC10978245 DOI: 10.1053/j.seminhematol.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/12/2024] [Accepted: 01/28/2024] [Indexed: 03/03/2024]
Abstract
Clonal hematopoiesis (CH) in autologous transplant recipients and allogeneic transplant donors has genetic features and clinical associations that are distinct from each other and from non-cancer populations. CH in the setting of autologous transplant is enriched for mutations in DNA damage response pathway genes and is associated with adverse outcomes, including an increased risk of therapy-related myeloid neoplasm and inferior overall survival. Studies of CH in allogeneic transplant donors have yielded conflicting results but have generally shown evidence of potentiated alloimmunity in recipients, with some studies showing an association with favorable recipient outcomes.
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Affiliation(s)
| | - R Coleman Lindsley
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA
| | - Lukasz P Gondek
- Division of Hematologic Malignancies, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD.
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2
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Dhaliwal A, Ravi S. Myelodysplastic Syndrome After Anti-CD19 Chimeric Antigen Receptor T-cell Therapy: A Case Series. Cureus 2023; 15:e44677. [PMID: 37809221 PMCID: PMC10550779 DOI: 10.7759/cureus.44677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
The utility of CD19-targeted chimeric antigen receptor T-cell (CAR-T cell) therapy in the management of refractory/relapsed B-cell malignancies has increased tremendously in recent times. In addition to cytokine release syndrome (CRS), neurotoxicity, and infections, CAR-T cell patients develop cytopenias, with about 15% of the patients continuing to have severe cytopenias up to three months after treatment. Retrospective reviews have reported the development of myelodysplastic syndrome (MDS) in patients undergoing CAR-T cell therapy. Here, we describe four cases of MDS and/or clonal cytopenias of undetermined significance (CCUS), developing after CAR-T cell therapy. A retrospective review of four patients with relapsed/refractory B-cell lymphomas treated with CD19-directed autologous CAR-T cell was conducted at our institution. The median age was 72.5 years (range 63-76). Three of the four patients had double-hit diffuse large B-cell lymphoma (DLBCL). The median number of lines of therapy before CAR-T cell was three. Only one patient had a prior autologous stem cell transplant (ASCT). The median time to diagnosis of MDS/CCUS from CAR-T cell therapy was three months. Two cases of CCUS diagnosed were at one- and two-month post-CAR-T cell, and two cases of MDS were diagnosed at 10 and 26 months. None of the patients had dysplastic clones before the initiation of CAR-T cell therapy. Only one patient was found to have CCUS-developed CRS post-CAR-T cell requiring treatment with tocilizumab and steroids. Three patients showed complete response, with one showing a very good partial response. All the patients were in remission with no additional therapies post-CAR-T cell. One patient died secondary to COVID-19-related complications. Four patients with prolonged cytopenias were found to have either MDS or CCUS after CAR-T cell therapy. Two CCUS cases underwent bone marrow evaluation early in the course of cytopenias and may develop into MDS, acute myeloid leukemia (AML), or myeloproliferative neoplasm over time. Our retrospective case series review, compared to previous studies, constitutes of patients with no prior clonal hematopoiesis-related cytogenetic abnormalities, fewer lines of therapy, and only one patient with previous hematopoietic stem cell transplantation (HSCT). Based on the upcoming data and our review, a bone marrow biopsy with next-generation sequencing (NGS) is imperative in patients with prolonged cytopenias after CAR-T cell therapy. A diagnosis of CCUS/MDS in these cases can help guide treatment.
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Affiliation(s)
- Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Soumiya Ravi
- Department of Internal Medicine, University of Arizona College of Medicine, Tucson, USA
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3
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Haeno T, Rai S, Miyake Y, Inoue M, Fujimoto K, Fujii A, Iwata Y, Minamoto S, Taniguchi T, Kakutani H, Inoue H, Kumode T, Serizawa K, Taniguchi Y, Hirase C, Morita Y, Tanaka H, Tatsumi Y, Ashida T, Matsumura I. Long-term effectiveness and safety of high dose chemotherapy followed by autologous stem cell transplantation in daily practice in patients with diffuse large B-cell lymphoma. J Clin Exp Hematop 2023; 63:99-107. [PMID: 37121716 PMCID: PMC10410619 DOI: 10.3960/jslrt.23001] [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: 01/08/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 05/02/2023] Open
Abstract
We retrospectively evaluated long-term outcomes of high dose chemotherapy followed by autologous stem cell transplant (HDC/ASCT) in patients with diffuse large B-cell lymphoma (DLBCL). Between 2004 and 2020, 46 DLBCL patients received HDC/ASCT in our institution, including 12 patients (26.1%), who received as an upfront setting (UFS). At a median follow-up time of 69 months (range, 2-169 months), the 5-year progression-free survival (PFS) rates were 82.5% (95%CI, 46.1-95.3%) in the UFS, and 57.8% (95%CI, 38.1-73.2%) in the relapsed or refractory (R/R) patients (n=34), respectively. The 5-year PFS rates were 62.3% (95%CI, 34.0-81.3%) in primary resistant (n=13) or early relapsing (within 1 year from the initial diagnosis) patients (n=4), and 53.3% (95%CI, 25.9-74.6%) in those relapsing >1 year after the initial diagnosis (n=17), with no statistically significant difference (p=0.498). In R/R patients, multivariate analysis showed that the remission status before HDC/ASCT was an independent poor prognostic factor for progression-free survival (hazard ratio [HR], 17.0; 95%CI, 3.35-86.6; p=0.000630) and high-risk category in the international prognostic index for OS (HR, 9.39; 95%CI, 1.71-51.6; p=0.0100). The incidence of non-relapse mortality by 5 years, and 10 years were 12.2%, and 15.2%, respectively. Eleven patients (23.9%) developed second malignancies, which was the most frequent late complication after HDC/ASCT, with 5-year, and 10-year cumulative incidence of 16.9%, 22.5%, respectively. In conclusion, HDC/ASCT is effective for chemo-sensitive R/R DLBCL regardless of the timing and lines of therapy. However, careful observation is required, considering the long-term complications such as secondary malignancies.
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Affiliation(s)
- Takahiro Haeno
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Shinya Rai
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Yoshiaki Miyake
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Maiko Inoue
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Ko Fujimoto
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Aki Fujii
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Yoshio Iwata
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Shuji Minamoto
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Takahide Taniguchi
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Hiroaki Kakutani
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Hiroaki Inoue
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Takahiro Kumode
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Kentaro Serizawa
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Yasuhiro Taniguchi
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Chikara Hirase
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Yasuyoshi Morita
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Hirokazu Tanaka
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Yoichi Tatsumi
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Takashi Ashida
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Kindai University Hospital, Osaka, Japan
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4
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Kim SY, Kim GJ, Bang JI, Shin HI, Sun DI. Are second primary head and neck cancers with previous hematological malignancy more aggressive than de novo head and neck cancers? Am J Otolaryngol 2023; 44:103748. [PMID: 36577170 DOI: 10.1016/j.amjoto.2022.103748] [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: 10/20/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Secondary solid tumors can occur after the treatment of hematological malignancies and are associated with a poor prognosis. We evaluated the survival outcomes of patients with second primary head and neck cancers according to the site of cancer origin, type of hematological malignancy, and age. MATERIALS AND METHODS We enrolled all patients who underwent surgery for second primary head and neck cancer and were previously treated for hematological malignancy between 1997 and 2020. We analyzed the survival outcomes of patients with second primary head and neck cancer, and compared them with 3126 de novo head and neck cancer patients diagnosed during the same period at our hospital. RESULTS The 5-year overall survival (OS) rate was significantly worse for second primary head and neck cancer patients than de novo cancer patients (52.0 % and 77.9 %, respectively; p = 0.04) and those results were similarly observed in second primary oral cavity cancer (33.3 % and 75.7 %, respectively; p < 0.01). Patients with myelodysplastic syndrome and acute myeloid leukemia showed significantly worse 5-year OS rate than those with other types of hematological malignancies (p = 0.036). Multivariate analysis showed that bone marrow transplantation (BMT) was a risk factor for the recurrence of head and neck cancers (odds ratio = 6.635, p = 0.042). CONCLUSION Patients with second primary head and neck cancer, particularly of the oral cavity, had a worse prognosis than patients with de novo head and neck cancer. BMT predicts recurrence in second primary head and neck cancer patients.
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Affiliation(s)
- Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-In Bang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun-Il Shin
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Il Sun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Lin M, Wu X, Zhang L, Li L, Wang X, Fu X, Sun Z, Zhang X, Zhu L, Yu H, Chang Y, Nan F, Yan J, Zhou Z, Shi C, Zhang M, Li X. Fotemustine, etoposide, cytarabine, and cyclophosphamide (FEAC) conditioning regimen for autologous stem cell transplantation in lymphoma. Leuk Lymphoma 2023; 64:605-612. [PMID: 36657436 DOI: 10.1080/10428194.2023.2167492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To investigate the efficacy and safety of the FEAC (fotemustine, etoposide, cytarabine, and cyclophosphamide) conditioning regimen for the treatment of lymphoma, we retrospectively analyzed the records of 76 Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) patients who underwent autologous stem cell transplantation (ASCT) after the FEAC conditioning regimen. Their survival, as well as the clinical efficacy, hematopoietic engraftment time, and toxicity, were analyzed. One patient died of severe pulmonary infection, and the transplant-related mortality (TRM) was 1.3% (1/76). Hematopoietic engraftment was achieved successfully in the remaining 75 patients. The median times of neutrophil and platelet engraftment were 11 d (6-21 d) and 13 d (8-24 d), respectively. The 2-year progression-free survival (PFS) rate was 69.1%, and the 2-year overall survival (OS) rate was 84.2%. FEAC conditioning regimen has acceptable toxicity, and the prognosis of patients is good, making it a feasible alternative to the BEAM regimen for ASCT.
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Affiliation(s)
- Meng Lin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xiaolong Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Linan Zhu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Hui Yu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Feifei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Jiaqin Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Zhiyuan Zhou
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Cunzhen Shi
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
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6
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Increased incidence of hematologic malignancies in SCD after HCT in adults with graft failure and mixed chimerism. Blood 2022; 140:2514-2518. [PMID: 36044658 PMCID: PMC9837433 DOI: 10.1182/blood.2022017960] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/21/2023] Open
Abstract
Lawal et al report on a 45-fold increase in secondary hematologic malignancy in 120 patients following hematopoietic stem cell transplantation (HSCT) for sickle cell disease (SCD), comparable to what has been reported following gene therapy. Notably, the cohort is enriched for older patients and for haploidentical transplant recipients with mixed chimerism following HSCT. These data further support the idea that pre-existing premalignant myeloid clones undergo clonal selection in the setting of nonmyeloablative HSCT and contribute to secondary malignancy.
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Nasr W, Filippi MD. Acquired and hereditary bone marrow failure: A mitochondrial perspective. Front Oncol 2022; 12:1048746. [PMID: 36408191 PMCID: PMC9666693 DOI: 10.3389/fonc.2022.1048746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/17/2022] [Indexed: 11/22/2022] Open
Abstract
The disorders known as bone marrow failure syndromes (BMFS) are life-threatening disorders characterized by absence of one or more hematopoietic lineages in the peripheral blood. Myelodysplastic syndromes (MDS) are now considered BMF disorders with associated cellular dysplasia. BMFs and MDS are caused by decreased fitness of hematopoietic stem cells (HSC) and poor hematopoiesis. BMF and MDS can occur de novo or secondary to hematopoietic stress, including following bone marrow transplantation or myeloablative therapy. De novo BMF and MDS are usually associated with specific genetic mutations. Genes that are commonly mutated in BMF/MDS are in DNA repair pathways, epigenetic regulators, heme synthesis. Despite known and common gene mutations, BMF and MDS are very heterogenous in nature and non-genetic factors contribute to disease phenotype. Inflammation is commonly found in BMF and MDS, and contribute to ineffective hematopoiesis. Another common feature of BMF and MDS, albeit less known, is abnormal mitochondrial functions. Mitochondria are the power house of the cells. Beyond energy producing machinery, mitochondrial communicate with the rest of the cells via triggering stress signaling pathways and by releasing numerous metabolite intermediates. As a result, mitochondria play significant roles in chromatin regulation and innate immune signaling pathways. The main goal of this review is to investigate BMF processes, with a focus mitochondria-mediated signaling in acquired and inherited BMF.
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Affiliation(s)
- Waseem Nasr
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children’s Research Foundation, Cincinnati, OH, United States,University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Marie-Dominique Filippi
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children’s Research Foundation, Cincinnati, OH, United States,University of Cincinnati College of Medicine, Cincinnati, OH, United States,*Correspondence: Marie-Dominique Filippi,
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8
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Angelopoulos I, Trigo C, Ortuzar MI, Cuenca J, Brizuela C, Khoury M. Delivery of affordable and scalable encapsulated allogenic/autologous mesenchymal stem cells in coagulated platelet poor plasma for dental pulp regeneration. Sci Rep 2022; 12:435. [PMID: 35013332 PMCID: PMC8748942 DOI: 10.1038/s41598-021-02118-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/28/2021] [Indexed: 12/23/2022] Open
Abstract
The main goal of regenerative endodontics procedures (REPs) is to revitalize teeth by the regeneration of healthy dental pulp. In this study, we evaluated the potential of combining a natural and accessible biomaterial based on Platelet Poor Plasma (PPP) as a support for dental pulp stem cells (DPSC) and umbilical cord mesenchymal stem cells (UC-MSC). A comparison study between the two cell sources revealed compatibility with the PPP based scaffold with differences noted in the proliferation and angiogenic properties in vitro. Additionally, the release of growth factors including VEGF, HGF and DMP-1, was detected in the media of cultured PPP and was enhanced by the presence of the encapsulated MSCs. Dentin-Discs from human molars were filled with PPP alone or with MSCs and implanted subcutaneously for 4 weeks in mice. Histological analysis of the MSC-PPP implants revealed a newly formed dentin-like structure evidenced by the expression of Dentin sialophosphoprotein (DSPP). Finally, DPSC induced more vessel formation around the dental discs. This study provides evidence of a cost-effective, xenofree scaffold that is compatible with either autologous or allogenic strategy for dental pulp regeneration. This attempt if successfully implemented, could make REPs treatment widely accessible, contributing in improving global health conditions.
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Affiliation(s)
- Ioannis Angelopoulos
- Laboratory of Nano-Regenerative Medicine, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
- Cells for Cells and REGENERO, The Chilean Consortium for Regenerative Medicine, Santiago, Chile
| | - Cesar Trigo
- Centro de Investigacion en Biologia y Regeneracion Oral (CIBRO), Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
| | - Maria-Ignacia Ortuzar
- Cells for Cells and REGENERO, The Chilean Consortium for Regenerative Medicine, Santiago, Chile
| | - Jimena Cuenca
- Laboratory of Nano-Regenerative Medicine, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
- Cells for Cells and REGENERO, The Chilean Consortium for Regenerative Medicine, Santiago, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile
| | - Claudia Brizuela
- Centro de Investigacion en Biologia y Regeneracion Oral (CIBRO), Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
| | - Maroun Khoury
- Laboratory of Nano-Regenerative Medicine, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile.
- Cells for Cells and REGENERO, The Chilean Consortium for Regenerative Medicine, Santiago, Chile.
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile.
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9
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Bachiashvili K, Francisco L, Chen Y, Bosworth A, Forman SJ, Bhatia R, Bhatia S. Peripheral blood parameter abnormalities precede therapy-related myeloid neoplasms after autologous transplantation for lymphoma. Cancer 2021; 128:1392-1401. [PMID: 34962652 DOI: 10.1002/cncr.34072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Therapy-related myeloid neoplasms (t-MN) are a leading cause of nonrelapse mortality after autologous peripheral blood stem cell transplantation (aPBSCT) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphomas (NHL). t-MN patients treated at an earlier stage of disease evolution have a better prognosis, and this presents a need to identify patients at risk for t-MN. METHODS Using a prospective longitudinal study design, this study evaluated peripheral blood parameters pre-aPBSCT and on day 100, at 6 months, 1 year, 2 years, and 3 years in 304 patients treated with aPBSCT. The relation between peripheral blood parameters and subsequent development of t-MN was examined, and nomograms were developed to identify patients at risk for t-MN. RESULTS Twenty-one patients developed t-MN at a median of 1.95 years post-aPBSCT. Hemoglobin, hematocrit, white blood cell, and platelet counts were lower among patients who developed t-MN compared to those who did not; these differences appeared soon after aPBSCT, persisted, and preceded development of t-MN. Older age at aPBSCT (hazard ratio [HR]per_year_increase = 1.08, P = .007), exposure to total body irradiation (TBI) (HR = 2.90, P = .04), and low 100-day platelet count (HRincrease_per_unit_decline_in_PLT = 1.01, P = .002) predicted subsequent t-MN. These parameters and primary diagnosis allowed identification of patients at high risk of t-MN (eg, an HL patient undergoing aPBSCT at the age of 70 years with TBI and with a day 100 PLT between 100,000 and 150,000 would have a 62% probability of developing t-MN at 6 years post-aPBSCT). CONCLUSIONS Abnormalities in peripheral blood parameters can identify patients at high risk for t-MN after aPBSCT for HL or NHL, allowing opportunities to personalize close surveillance and possible disease-modifying interventions.
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Affiliation(s)
- Kimo Bachiashvili
- Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Stephen J Forman
- Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ravi Bhatia
- Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.,Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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10
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Cappell KM, Sherry RM, Yang JC, Goff SL, Vanasse DA, McIntyre L, Rosenberg SA, Kochenderfer JN. Long-Term Follow-Up of Anti-CD19 Chimeric Antigen Receptor T-Cell Therapy. J Clin Oncol 2020; 38:3805-3815. [PMID: 33021872 DOI: 10.1200/jco.20.01467] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Anti-CD19 chimeric antigen receptors (CARs) are artificial fusion proteins that cause CD19-specific T-cell activation. Durability of remissions and incidence of long-term adverse events are critical factors determining the utility of anti-CD19 CAR T-cell therapy, but long-term follow-up of patients treated with anti-CD19 CAR T cells is limited. This work provides the longest follow-up of patients in remission after anti-CD19 CAR T-cell therapy. METHODS Between 2009 and 2015, we administered 46 CAR T-cell treatments to 43 patients (ClinicalTrials.gov identifier: NCT00924326). Patients had relapsed B-cell malignancies of the following types: diffuse large B-cell lymphoma or primary mediastinal B-cell lymphoma (DLBCL/PMBCL; n = 28), low-grade B-cell lymphoma (n = 8), or chronic lymphocytic leukemia (CLL; n = 7). This report focuses on long-term outcomes of these patients. The CAR used was FMC63-28Z; axicabtagene ciloleucel uses the same CAR. Cyclophosphamide plus fludarabine conditioning chemotherapy was administered before CAR T cells. RESULTS The percentages of CAR T-cell treatments resulting in a > 3-year duration of response (DOR) were 51% (95% CI, 35% to 67%) for all evaluable treatments, 48% (95% CI, 28% to 69%) for DLBCL/PMBCL, 63% (95% CI, 25% to 92%) for low-grade lymphoma, and 50% (95% CI, 16% to 84%) for CLL. The median event-free survival of all 45 evaluable treatments was 55 months. Long-term adverse effects were rare, except for B-cell depletion and hypogammaglobulinemia. Median peak blood CAR-positive cell levels were higher among patients with a DOR of > 3 years (98/µL; range, 9-1,217/µL) than among patients with a DOR of < 3 years (18/µL; range, 0-308/μL, P = .0051). CONCLUSION Complete remissions of a variety of B-cell malignancies lasting ≥ 3 years occurred after 51% of evaluable anti-CD19 CAR T-cell treatments. Remissions of up to 9 years are ongoing. Late adverse events were rare.
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Affiliation(s)
- Kathryn M Cappell
- National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute Medical Oncology/Hematology Fellowship Program, Bethesda, MD
| | - Richard M Sherry
- Surgery Branch, Center for Cancer Research, National Cancer Istitute, NIH, Bethesda, MD
| | - James C Yang
- Surgery Branch, Center for Cancer Research, National Cancer Istitute, NIH, Bethesda, MD
| | - Stephanie L Goff
- Surgery Branch, Center for Cancer Research, National Cancer Istitute, NIH, Bethesda, MD
| | - Danielle A Vanasse
- Surgery Branch, Center for Cancer Research, National Cancer Istitute, NIH, Bethesda, MD
| | - Lori McIntyre
- Surgery Branch, Center for Cancer Research, National Cancer Istitute, NIH, Bethesda, MD
| | - Steven A Rosenberg
- Surgery Branch, Center for Cancer Research, National Cancer Istitute, NIH, Bethesda, MD
| | - James N Kochenderfer
- Surgery Branch, Center for Cancer Research, National Cancer Istitute, NIH, Bethesda, MD
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Strati P, Varma A, Adkins S, Nastoupil LJ, Westin JR, Hagemeister FB, Fowler NH, Lee HJ, Fayad LE, Samaniego F, Ahmed S, Chen Y, Horowitz S, Arafat S, Johncy S, Kebriaei P, Mulanovich VE, Heredia EA, Neelapu SS. Hematopoietic recovery and immune reconstitution after axicabtagene ciloleucel in patients with large B-cell lymphoma. Haematologica 2020; 106:2667-2672. [PMID: 32732355 PMCID: PMC8485681 DOI: 10.3324/haematol.2020.254045] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Indexed: 11/16/2022] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy targeting CD19 may be associated with long-term adverse effects such as cytopenia and immune deficiency. In order to characterize these late events, we analyzed 31 patients with relapsed or refractory large B-cell lymphoma treated with axicabtagene ciloleucel at our institution on two clinical trials, ZUMA-1 (clinicaltrials gov. Identifier: NCT02348216) and ZUMA-9 (clinicaltrials gov. Identifier: NCT03153462). Complete blood counts, lymphocyte subsets, and immunoglobulin levels were measured serially until month 24 or progression. Fifteen (48%) patients had grade 3-4 cytopenia, including anemia (five, 16%), neutropenia (nine, 29%), or thrombocytopenia (13, 42%) at day 30. Cytopenia at day 30 was not significantly associated with later diagnosis of myelodysplasia. Among patients with ongoing remission, grade 3-4 cytopenia was observed in one of nine (11%) at 2 years. While peripheral CD8+ T cells recovered early, CD4+ T-cell recovery was delayed with a count of <200/mL in three of nine (33%) patients at 1 year and two of seven (29%) at 2 years. Immunoglobulin G levels normalized in five of nine (56%) patients at 2 years. Thirteen (42%) patients developed grade 3-4 infectious complications, including herpes zoster and Pneumocystis jiroveci pneumonia. These results suggest the need for prolonged monitoring and prophylaxis against opportunistic infections in these patients, to improve the longterm safety of axicabtagene ciloleucel therapy.
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Affiliation(s)
- Paolo Strati
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ankur Varma
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
- Division of Hematology, Oncology and Cellular Therapy, Rush University, Chicago, IL, USA
| | - Sherry Adkins
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Loretta J. Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason R. Westin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Fredrick B Hagemeister
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nathan H Fowler
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hun J. Lee
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Luis E. Fayad
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yiming Chen
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sandra Horowitz
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sara Arafat
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Swapna Johncy
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ella Ariza Heredia
- Department of Infectious Disease, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sattva S. Neelapu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
- SATTVA S. NEELAPU
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Englinger B, Pirker C, Heffeter P, Terenzi A, Kowol CR, Keppler BK, Berger W. Metal Drugs and the Anticancer Immune Response. Chem Rev 2018; 119:1519-1624. [DOI: 10.1021/acs.chemrev.8b00396] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Bernhard Englinger
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Borschkegasse 8a, A-1090 Vienna, Austria
| | - Christine Pirker
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Borschkegasse 8a, A-1090 Vienna, Austria
| | - Petra Heffeter
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Borschkegasse 8a, A-1090 Vienna, Austria
- Research Cluster “Translational Cancer Therapy Research”, University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Alessio Terenzi
- Research Cluster “Translational Cancer Therapy Research”, University of Vienna and Medical University of Vienna, Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, A-1090 Vienna, Austria
| | - Christian R. Kowol
- Research Cluster “Translational Cancer Therapy Research”, University of Vienna and Medical University of Vienna, Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, A-1090 Vienna, Austria
| | - Bernhard K. Keppler
- Research Cluster “Translational Cancer Therapy Research”, University of Vienna and Medical University of Vienna, Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, A-1090 Vienna, Austria
| | - Walter Berger
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University of Vienna, Borschkegasse 8a, A-1090 Vienna, Austria
- Research Cluster “Translational Cancer Therapy Research”, University of Vienna and Medical University of Vienna, Vienna, Austria
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Grisariu S, Shapira MY, Or R, Avni B. Thiotepa, Etoposide, Cyclophosphamide, Cytarabine, and Melphalan (TECAM) Conditioning Regimen for Autologous Stem Cell Transplantation in Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:272-279. [DOI: 10.1016/j.clml.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/16/2018] [Accepted: 02/10/2018] [Indexed: 10/18/2022]
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Kochenderfer JN, Somerville RPT, Lu T, Shi V, Bot A, Rossi J, Xue A, Goff SL, Yang JC, Sherry RM, Klebanoff CA, Kammula US, Sherman M, Perez A, Yuan CM, Feldman T, Friedberg JW, Roschewski MJ, Feldman SA, McIntyre L, Toomey MA, Rosenberg SA. Lymphoma Remissions Caused by Anti-CD19 Chimeric Antigen Receptor T Cells Are Associated With High Serum Interleukin-15 Levels. J Clin Oncol 2017; 35:1803-1813. [PMID: 28291388 DOI: 10.1200/jco.2016.71.3024] [Citation(s) in RCA: 405] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose T cells genetically modified to express chimeric antigen receptors (CARs) targeting CD19 (CAR-19) have potent activity against acute lymphoblastic leukemia, but fewer results supporting treatment of lymphoma with CAR-19 T cells have been published. Patients with lymphoma that is chemotherapy refractory or relapsed after autologous stem-cell transplantation have a grim prognosis, and new treatments for these patients are clearly needed. Chemotherapy administered before adoptive T-cell transfer has been shown to enhance the antimalignancy activity of adoptively transferred T cells. Patients and Methods We treated 22 patients with advanced-stage lymphoma in a clinical trial of CAR-19 T cells preceded by low-dose chemotherapy. Nineteen patients had diffuse large B-cell lymphoma, two patients had follicular lymphoma, and one patient had mantle cell lymphoma. Patients received a single dose of CAR-19 T cells 2 days after a low-dose chemotherapy conditioning regimen of cyclophosphamide plus fludarabine. Results The overall remission rate was 73% with 55% complete remissions and 18% partial remissions. Eleven of 12 complete remissions are ongoing. Fifty-five percent of patients had grade 3 or 4 neurologic toxicities that completely resolved. The low-dose chemotherapy conditioning regimen depleted blood lymphocytes and increased serum interleukin-15 (IL-15). Patients who achieved a remission had a median peak blood CAR+ cell level of 98/μL and those who did not achieve a remission had a median peak blood CAR+ cell level of 15/μL ( P = .027). High serum IL-15 levels were associated with high peak blood CAR+ cell levels ( P = .001) and remissions of lymphoma ( P < .001). Conclusion CAR-19 T cells preceded by low-dose chemotherapy induced remission of advanced-stage lymphoma, and high serum IL-15 levels were associated with the effectiveness of this treatment regimen. CAR-19 T cells will likely become an important treatment for patients with relapsed lymphoma.
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Affiliation(s)
- James N Kochenderfer
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Robert P T Somerville
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Tangying Lu
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Victoria Shi
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Adrian Bot
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - John Rossi
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Allen Xue
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Stephanie L Goff
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - James C Yang
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Richard M Sherry
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Christopher A Klebanoff
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Udai S Kammula
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Marika Sherman
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Arianne Perez
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Constance M Yuan
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Tatyana Feldman
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Jonathan W Friedberg
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Mark J Roschewski
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Steven A Feldman
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Lori McIntyre
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Mary Ann Toomey
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
| | - Steven A Rosenberg
- James N. Kochenderfer, Robert P.T. Somerville, Tangying Lu, Victoria Shi, Stephanie L. Goff, James C. Yang, Richard M. Sherry, Christopher A. Klebanoff, Udai S. Kammula, Constance M. Yuan, Mark J. Roschewski, Steven A. Feldman, Lori McIntyre, Mary Ann Toomey, and Steven A. Rosenberg, National Cancer Institute, National Institutes of Health, Bethesda, MD; Adrian Bot, John Rossi, Allen Xue, Marika Sherman, and Arianne Perez, Kite Pharma, Santa Monica, CA; Tatyana Feldman, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; and Jonathan W. Friedberg, University of Rochester School of Medicine, Rochester, NY
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Morton LM, Saber W, Baker KS, Barrett AJ, Bhatia S, Engels EA, Gadalla SM, Kleiner DE, Pavletic S, Burns LJ. National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report. Biol Blood Marrow Transplant 2017; 23:367-378. [PMID: 27634019 PMCID: PMC5285307 DOI: 10.1016/j.bbmt.2016.09.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 01/06/2023]
Abstract
Subsequent neoplasms (SN) after hematopoietic cell transplantation (HCT) cause significant patient morbidity and mortality. Risks for specific SN types vary substantially, with particularly elevated risks for post-transplantation lymphoproliferative disorders, myelodysplastic syndrome/acute myeloid leukemia, and squamous cell malignancies. This document provides an overview of the current state of knowledge regarding SN after HCT and recommends priorities and approaches to overcome challenges and gaps in understanding. Numerous factors have been suggested to affect risk, including patient-related (eg, age), primary disease-related (eg, disease type, pre-HCT therapies), and HCT-related characteristics (eg, type and intensity of conditioning regimen, stem cell source, development of graft-versus-host disease). However, gaps in understanding remain for each of these risk factors, particularly for patients receiving HCT in the current era because of substantial advances in clinical transplantation practices. Additionally, the influence of nontransplantation-related risk factors (eg, germline genetic susceptibility, oncogenic viruses, lifestyle factors) is poorly understood. Clarification of the magnitude of SN risks and identification of etiologic factors will require large-scale, long-term, systematic follow-up of HCT survivors with detailed clinical data. Most investigations of the mechanisms of SN pathogenesis after HCT have focused on immune drivers. Expansion of our understanding in this area will require interdisciplinary laboratory collaborations utilizing measures of immune function and availability of archival tissue from SN diagnoses. Consensus-based recommendations for optimal preventive, screening, and therapeutic approaches have been developed for certain SN after HCT, whereas for other SN, general population guidelines are recommended. Further evidence is needed to specifically tailor preventive, screening, and therapeutic guidelines for SN after HCT, particularly for unique patient populations. Accomplishment of this broad research agenda will require increased investment in systematic data collection with engagement from patients, clinicians, and interdisciplinary scientists to reduce the burden of SN in the rapidly growing population of HCT survivors.
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Affiliation(s)
- Lindsay M Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - A John Barrett
- Stem Cell Transplantation Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Shahinaz M Gadalla
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David E Kleiner
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven Pavletic
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Linda J Burns
- National Marrow Donor Program/Be The Match and Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
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Reprint of: Long-Term Survivorship after Hematopoietic Cell Transplantation: Roadmap for Research and Care. Biol Blood Marrow Transplant 2017; 23:S1-S9. [PMID: 28236836 DOI: 10.1016/j.bbmt.2017.01.001] [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] [Received: 09/15/2016] [Accepted: 11/02/2016] [Indexed: 12/23/2022]
Abstract
The number of survivors after hematopoietic cell transplantation (HCT) is expected to dramatically increase over the next decade. Significant and unique challenges confront survivors for decades after their underlying indication (malignancy or marrow failure) has been cured by HCT. The National Institutes of Health (NIH) Late Effects Consensus Conference in June 2016 brought together international experts in the field to plan the next phase of survivorship efforts. Working groups laid out the roadmap for collaborative research and health care delivery. Potentially lethal late effects (cardiac/vascular, subsequent neoplasms, and infectious), patient-centered outcomes, health care delivery, and research methodology are highlighted here. Important recommendations from the NIH Consensus Conference provide fresh perspectives for the future. As HCT evolves into a safer and higher-volume procedure, this marks a time for concerted action to ensure that no survivor is left behind.
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Lacoste S, Bhatia S, Chen Y, Bhatia R, O’Connor TR. Autologous hematopoietic stem cell transplantation in lymphoma patients is associated with a decrease in the double strand break repair capacity of peripheral blood lymphocytes. PLoS One 2017; 12:e0171473. [PMID: 28207808 PMCID: PMC5313139 DOI: 10.1371/journal.pone.0171473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
Patients who undergo autologous hematopoietic stem cell transplantation (aHCT) for treatment of a relapsed or refractory lymphoma are at risk of developing therapy related- myelodysplasia/acute myeloid leukemia (t-MDS/AML). Part of the risk likely resides in inherent interindividual differences in their DNA repair capacity (DRC), which is thought to influence the effect chemotherapeutic treatments have on the patient's stem cells prior to aHCT. Measuring DRC involves identifying small differences in repair proficiency among individuals. Initially, we investigated the cell model in healthy individuals (primary lymphocytes and/or lymphoblastoid cell lines) that would be appropriate to measure genetically determined DRC using host-cell reactivation assays. We present evidence that interindividual differences in DRC double-strand break repair (by non-homologous end-joining [NHEJ] or single-strand annealing [SSA]) are better preserved in non-induced primary lymphocytes. In contrast, lymphocytes induced to proliferate are required to assay base excision (BER) or nucleotide excision repair (NER). We established that both NHEJ and SSA DRCs in lymphocytes of healthy individuals were inversely correlated with the age of the donor, indicating that DSB repair in lymphocytes is likely not a constant feature but rather something that decreases with age (~0.37% NHEJ DRC/year). To investigate the predictive value of pre-aHCT DRC on outcome in patients, we then applied the optimized assays to the analysis of primary lymphocytes from lymphoma patients and found that individuals who later developed t-MDS/AML (cases) were indistinguishable in their DRC from controls who never developed t-MDS/AML. However, when DRC was investigated shortly after aHCT in the same individuals (21.6 months later on average), aHCT patients (both cases and controls) showed a significant decrease in DSB repair measurements. The average decrease of 6.9% in NHEJ DRC observed among aHCT patients was much higher than the 0.65% predicted for such a short time frame, based on ageing results for healthy individuals.
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Affiliation(s)
- Sandrine Lacoste
- Department of Cancer Biology, Beckman Research Institute, Duarte, California, United States of America
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ravi Bhatia
- Division of Hematology and Oncology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Timothy R. O’Connor
- Department of Cancer Biology, Beckman Research Institute, Duarte, California, United States of America
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Battiwalla M, Tichelli A, Majhail NS. Long-Term Survivorship after Hematopoietic Cell Transplantation: Roadmap for Research and Care. Biol Blood Marrow Transplant 2017; 23:184-192. [PMID: 27818318 PMCID: PMC5237604 DOI: 10.1016/j.bbmt.2016.11.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/02/2016] [Indexed: 12/16/2022]
Abstract
The number of survivors after hematopoietic cell transplantation (HCT) is expected to dramatically increase over the next decade. Significant and unique challenges confront survivors for decades after their underlying indication (malignancy or marrow failure) has been cured by HCT. The National Institutes of Health (NIH) Late Effects Consensus Conference in June 2016 brought together international experts in the field to plan the next phase of survivorship efforts. Working groups laid out the roadmap for collaborative research and health care delivery. Potentially lethal late effects (cardiac/vascular, subsequent neoplasms, and infectious), patient-centered outcomes, health care delivery, and research methodology are highlighted here. Important recommendations from the NIH Consensus Conference provide fresh perspectives for the future. As HCT evolves into a safer and higher-volume procedure, this marks a time for concerted action to ensure that no survivor is left behind.
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Affiliation(s)
- Minoo Battiwalla
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
| | | | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
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20
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Carmustine replacement in intensive chemotherapy preceding reinjection of autologous HSCs in Hodgkin and non-Hodgkin lymphoma: a review. Bone Marrow Transplant 2017; 52:941-949. [DOI: 10.1038/bmt.2016.340] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 11/08/2016] [Accepted: 11/16/2016] [Indexed: 11/08/2022]
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Gibson CJ, Lindsley RC, Tchekmedyian V, Mar BG, Shi J, Jaiswal S, Bosworth A, Francisco L, He J, Bansal A, Morgan EA, Lacasce AS, Freedman AS, Fisher DC, Jacobsen E, Armand P, Alyea EP, Koreth J, Ho V, Soiffer RJ, Antin JH, Ritz J, Nikiforow S, Forman SJ, Michor F, Neuberg D, Bhatia R, Bhatia S, Ebert BL. Clonal Hematopoiesis Associated With Adverse Outcomes After Autologous Stem-Cell Transplantation for Lymphoma. J Clin Oncol 2017; 35:1598-1605. [PMID: 28068180 DOI: 10.1200/jco.2016.71.6712] [Citation(s) in RCA: 306] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose Clonal hematopoiesis of indeterminate potential (CHIP) is an age-related condition characterized by somatic mutations in the blood of otherwise healthy adults. We hypothesized that in patients undergoing autologous stem-cell transplantation (ASCT) for lymphoma, CHIP at the time of ASCT would be associated with an increased risk of myelodysplastic syndrome and acute myeloid leukemia, collectively termed therapy-related myeloid neoplasm (TMN), and other adverse outcomes. Methods We performed whole-exome sequencing on pre- and post-ASCT samples from 12 patients who developed TMN after autologous transplantation for Hodgkin lymphoma or non-Hodgkin lymphoma and targeted sequencing on cryopreserved aliquots of autologous stem-cell products from 401 patients who underwent ASCT for non-Hodgkin lymphoma between 2003 and 2010. We assessed the effect of CHIP at the time of ASCT on subsequent outcomes, including TMN, cause-specific mortality, and overall survival. Results For six of 12 patients in the exome sequencing cohort, mutations found in the TMN specimen were also detectable in the pre-ASCT specimen. In the targeted sequencing cohort, 120 patients (29.9%) had CHIP at the time of ASCT, which was associated with an increased rate of TMN (10-year cumulative incidence, 14.1% v 4.3% for those with and without CHIP, respectively; P = .002). Patients with CHIP had significantly inferior overall survival compared with those without CHIP (10-year overall survival, 30.4% v 60.9%, respectively; P < .001), including increased risk of death from TMN and cardiovascular disease. Conclusion In patients undergoing ASCT for lymphoma, CHIP at the time of transplantation is associated with inferior survival and increased risk of TMN.
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Affiliation(s)
- Christopher J Gibson
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - R Coleman Lindsley
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Vatche Tchekmedyian
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Brenton G Mar
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Jiantao Shi
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Siddhartha Jaiswal
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Alysia Bosworth
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Liton Francisco
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Jianbo He
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Anita Bansal
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth A Morgan
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Ann S Lacasce
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Arnold S Freedman
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - David C Fisher
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Eric Jacobsen
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Philippe Armand
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Edwin P Alyea
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - John Koreth
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Vincent Ho
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Robert J Soiffer
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Joseph H Antin
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Jerome Ritz
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Sarah Nikiforow
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Stephen J Forman
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Franziska Michor
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Donna Neuberg
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Ravi Bhatia
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Benjamin L Ebert
- Christopher J. Gibson, R. Coleman Lindsley, Brenton G. Mar, Jiantao Shi, Ann S. Lacasce, Arnold S. Freedman, David C. Fisher, Eric Jacobsen, Philippe Armand, Edwin P. Alyea, John Koreth, Vincent Ho, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Sarah Nikiforow, Franziska Michor, and Donna Neuberg, Dana-Farber Cancer Institute; Jiantao Shi and Franziska Michor, Harvard T.H. Chan School of Public Health; Siddhartha Jaiswal, Elizabeth A. Morgan, and Benjamin L. Ebert, Brigham and Women's Hospital, Boston; Benjamin L. Ebert, Broad Institute, Cambridge, MA; Vatche Tchekmedyian, Memorial Sloan Kettering Cancer Center, New York, NY; Alysia Bosworth, Anita Bansal, and Stephen J. Forman, City of Hope National Medical Center, Duarte, CA; and Liton Francisco, Jianbo He, Ravi Bhatia, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
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22
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Abou Zahr A, Kavi AM, Mukherjee S, Zeidan AM. Therapy-related myelodysplastic syndromes, or are they? Blood Rev 2016; 31:119-128. [PMID: 27923516 DOI: 10.1016/j.blre.2016.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/14/2016] [Accepted: 11/22/2016] [Indexed: 12/12/2022]
Abstract
The incidence of therapy-related myelodysplastic syndromes (t-MDS) is increasing as the number of cancer survivors is increasing. While t-MDS is currently defined descriptively by prior receipt of chemotherapy and/or radiotherapy, some forms of MDS that occur post localized radiation monotherapy, biologically and clinically resemble de novo (d)-MDS more than t-MDS, and therefore may not be truly therapy-related. Although patients with t-MDS, as a group, fare worse than patients with d-MDS, a variation in individual outcomes of patients with t-MDS has increasingly been appreciated. As such, accurate risk stratification is important for counseling of patients and for clinical decision making. Most of the current clinical tools used for prognostication in t-MDS were developed for d-MDS and were not specifically validated in patients with t-MDS. The management of patients with t-MDS remains challenging, highlighting the importance of developing effective prevention strategies as well as newer, targeted, and rationally-designed therapeutic interventions.
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Affiliation(s)
- Abdallah Abou Zahr
- Section of Hematology/Oncology, Department of Internal Medicine, Mount Sinai Beth Israel, New York City, New York, NY, USA
| | - Ami M Kavi
- Department of Internal Medicine, Mount Sinai Beth Israel, New York City, New York, NY, USA
| | - Sudipto Mukherjee
- Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Amer M Zeidan
- Section of Hematology, Department of Medicine, Yale University, New Haven, CT, USA.
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23
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A retrospective comparison of toxicity and initial efficacy of two autologous stem cell transplant conditioning regimens for relapsed lymphoma: LEAM and BEAM. Bone Marrow Transplant 2016; 51:1397-1399. [DOI: 10.1038/bmt.2016.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Chow EJ, Anderson L, Baker KS, Bhatia S, Guilcher GMT, Huang JT, Pelletier W, Perkins JL, Rivard LS, Schechter T, Shah AJ, Wilson KD, Wong K, Grewal SS, Armenian SH, Meacham LR, Mulrooney DA, Castellino SM. Late Effects Surveillance Recommendations among Survivors of Childhood Hematopoietic Cell Transplantation: A Children's Oncology Group Report. Biol Blood Marrow Transplant 2016; 22:782-95. [PMID: 26802323 PMCID: PMC4826622 DOI: 10.1016/j.bbmt.2016.01.023] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/12/2016] [Indexed: 12/12/2022]
Abstract
Hematopoietic cell transplantation (HCT) is an important curative treatment for children with high-risk hematologic malignancies, solid tumors, and, increasingly, nonmalignant diseases. Given improvements in care, there are a growing number of long-term survivors of pediatric HCT. Compared with childhood cancer survivors who did not undergo transplantation, HCT survivors have a substantially increased burden of serious chronic conditions and impairments involving virtually every organ system and overall quality of life. This likely reflects the joint contributions of pretransplantation treatment exposures and organ dysfunction, the transplantation conditioning regimen, and any post-transplantation graft-versus-host disease (GVHD). In response, the Children's Oncology Group (COG) has created long-term follow-up guidelines (www.survivorshipguidelines.org) for survivors of childhood, adolescent, and young adult cancer, including those who were treated with HCT. Guideline task forces, consisting of HCT specialists, other pediatric oncologists, radiation oncologists, organ-specific subspecialists, nurses, social workers, other health care professionals, and patient advocates systematically reviewed the literature with regards to late effects after childhood cancer and HCT since 2002, with the most recent review completed in 2013. For the most recent review cycle, over 800 articles from the medical literature relevant to childhood cancer and HCT survivorship were reviewed, including 586 original research articles. Provided herein is an organ system-based overview that emphasizes the most relevant COG recommendations (with accompanying evidence grade) for the long-term follow-up care of childhood HCT survivors (regardless of current age) based on a rigorous review of the available evidence. These recommendations cover both autologous and allogeneic HCT survivors, those who underwent transplantation for nonmalignant diseases, and those with a history of chronic GVHD.
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Affiliation(s)
- Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, Washington.
| | - Lynnette Anderson
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - K Scott Baker
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory M T Guilcher
- Departments of Oncology and Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer T Huang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wendy Pelletier
- Departments of Oncology and Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Joanna L Perkins
- Department of Cancer and Blood Disorders, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - Linda S Rivard
- Department of Pediatric Hematology Oncology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Tal Schechter
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ami J Shah
- Division of Stem Cell Transplant and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | - Karla D Wilson
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Kenneth Wong
- Department of Radiation Oncology, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, California
| | - Satkiran S Grewal
- Department of Pediatrics, Baystate Children's Hospital, Tufts University School of Medicine, Springfield, Massachusetts
| | - Saro H Armenian
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Lillian R Meacham
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sharon M Castellino
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
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25
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Lahoud OB, Sauter CS, Hamlin PA, Dahi PB. High-Dose Chemotherapy and Autologous Stem Cell Transplant in Older Patients with Lymphoma. Curr Oncol Rep 2015. [PMID: 26201264 DOI: 10.1007/s11912-015-0465-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
High-dose chemotherapy followed by autologous hematopoietic stem cell transplant (HDT/ASCT) can improve survival in patients with lymphoma. Limited experience is available on the safety and efficacy of HDT/ASCT in elderly patients. In this article, we review the published data on the role of HDT/ASCT in management of lymphoma in older patients. Based on available data, evaluation of comorbidities, functional status, and comprehensive geriatric assessment (CGA) will help identify those who can benefit most from this intervention. Prospective clinical trials focusing on HDT/ASCT in older patients with lymphoma are needed to establish optimal management protocols in this select population.
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Affiliation(s)
- Oscar B Lahoud
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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26
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Affiliation(s)
- Myrna Candelaria
- 1Instituto Nacional de Cancerología Mexico, Ave. San Fernando 22, Seccion XVI, Tlalpan, Mexico City, Mexico
| | - Alfonso Dueñas-Gonzalez
- 2Instituto de Investigaciones Biomédicas UNAM/Instituto Nacional de Cancerología Mexico, Unit of Biomedical Research on Cancer, Ave. San Fernando 22, Seccion XVI, Tlalpan, Mexico City, Mexico
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27
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Vaxman I, Ram R, Gafter-Gvili A, Vidal L, Yeshurun M, Lahav M, Shpilberg O. Secondary malignancies following high dose therapy and autologous hematopoietic cell transplantation-systematic review and meta-analysis. Bone Marrow Transplant 2015; 50:706-14. [PMID: 25665042 DOI: 10.1038/bmt.2014.325] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 11/09/2022]
Abstract
We performed a systematic review and meta-analysis of randomized controlled trials comparing autologous hematopoietic cell transplantation (HCT) with other treatment modalities to analyze the risk for various secondary malignancies (SMs). Relative risks (RR) with 95% confidence intervals were estimated and pooled. Our search yielded 36 trials. The median follow-up was 55 (range 12-144) months. Overall, the RR for developing SMs was 1.23 ((0.97-1.55), I(2)=4%, 9870 patients). Subgroup analysis of trials assessing TBI-containing preparative regimens and of patients with baseline lymphoproliferative diseases, showed there was a higher risk for SMs in patients given autografts (RR=1.61 (1.05-2.48), I(2)=14%, 2218 patients and RR=1.62 (1.12-2.33), I(2)=22%, 3343 patients, respectively). Among all patients, there was a higher rate of myelodysplastic syndrome MDS/AML in patients given HCT compared with other treatments (RR=1.71 (1.18-2.48), I(2)=0%, 8778 patients). The risk of secondary solid malignancies was comparable in the short term between patients given HCT and patients given other treatments (RR=0.95 (0.67-1.32), I(2)=0%, 5925 patients). We conclude that overall the risk of secondary MDS/AML is higher in patients given autologous HCT compared with other treatments. In the subgroup of patients given a TBI-based regimen and in those with a baseline lymphoproliferative disease, there was a higher risk of overall SMs.
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Affiliation(s)
- I Vaxman
- 1] Medicine A, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel [2] Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Ram
- 1] Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel [2] BMT Unit, Sourasky Medical Center, Tel Aviv, Israel
| | - A Gafter-Gvili
- 1] Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel [2] Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Tel Aviv, Israel
| | - L Vidal
- 1] Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel [2] Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Tel Aviv, Israel
| | - M Yeshurun
- 1] Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel [2] Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Tel Aviv, Israel
| | - M Lahav
- 1] Medicine A, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel [2] Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Shpilberg
- 1] Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel [2] Institute of Hematology, Assuta Medical Center, Tel Aviv, Israel
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28
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Pemmaraju N, Shah D, Kantarjian H, Orlowski RZ, Nogueras González GM, Baladandayuthapani V, Jain N, Wagner V, Garcia-Manero G, Shah J, Ravandi F, Pierce S, Takahashi K, Daver N, Nazha A, Verstovsek S, Jabbour E, De Lima M, Champlin R, Cortes J, Qazilbash MH. Characteristics and outcomes of patients with multiple myeloma who develop therapy-related myelodysplastic syndrome, chronic myelomonocytic leukemia, or acute myeloid leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:110-4. [PMID: 25107338 DOI: 10.1016/j.clml.2014.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/08/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with multiple myeloma (MM) have had significant improvements in outcomes. An increased risk of therapy-related myeloid neoplasms (t-MNs) has also developed. Little is known about the characteristics and outcomes of these patients. PATIENTS AND METHODS Patients with MM treated at our institution from 1993 to 2011 were reviewed. Forty-seven patients were diagnosed with t-MN. Our primary objective was to evaluate the interval to t-MN, response to treatment, and overall survival (OS). RESULTS The median patient age at the MM diagnosis was 65 years. Of the 47 patients, 32 (68.0%) initially received conventional chemotherapeutic agents, 7 (14.9%), novel agents (eg, lenalidomide, thalidomide, bortezomib), and 8 (17.0%), a combination. Twenty patients (42.6%) underwent high-dose chemotherapy and autologous hematopoietic stem cell transplantation. The median interval from the MM diagnosis to t-MN was 7 years (95% CI, 5.0-28.0). Of the 47 patients, 33 (70.2%) developed therapy-related myelodysplastic syndrome (t-MDS), 11 (23.4%) acute myeloid leukemia (t-AML), and 3 (6.4%) chronic myelomonocytic leukemia (t-CMML). The median age at the t-MN diagnosis was 65 years. Of the 47 patients, 26 (78.8%) with t-MDS, 9 (81.8%) with t-AML, and 1 (33.3%) with t-CMML had complex/high-risk cytogenetics. The median OS for all 47 patients after the t-MN diagnosis was 6.3 months (95% CI, 4.0-8.7). CONCLUSION The development of t-MN in patients with MM is associated with poor outcomes. These patients, in general, have complex cytogenetic abnormalities and short complete remission and OS times. A better understanding of the disease biology and novel therapeutic approaches are warranted.
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Affiliation(s)
- Naveen Pemmaraju
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX.
| | - Dhaval Shah
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Hagop Kantarjian
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Robert Z Orlowski
- Department of Lymphoma/Myeloma, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | | | - Nitin Jain
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Verena Wagner
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | - Jatin Shah
- Department of Lymphoma/Myeloma, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Farhad Ravandi
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Sherry Pierce
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Koichi Takahashi
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Naval Daver
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Aziz Nazha
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Srdan Verstovsek
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Elias Jabbour
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Marcos De Lima
- Department of Stem Cell Transplantation, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Richard Champlin
- Department of Hematology and Oncology, Case Western Reserve University, Cleveland, OH
| | - Jorge Cortes
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Muzaffar H Qazilbash
- Department of Hematology and Oncology, Case Western Reserve University, Cleveland, OH
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29
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Abstract
Therapy-related leukemia (myelodysplasia and acute myeloid leukemia-t-MDS/AML) is a well-known complication of conventional chemoradiotherapy used to treat a variety of primary malignancies including Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia (ALL), sarcoma, and ovarian and testicular cancers. The median time to development of t-MDS/AML is 3-5 years, with the risk decreasing markedly after the first decade. t-MDS/AML is the major cause of non-relapse mortality after autologous hematopoietic cell transplantation (HCT) for HL or NHL. The magnitude of risk of t-MDS/AML is higher, and the latency is shorter after HCT, compared to conventional therapy. Two types of t-MDS/AML are recognized depending on the causative therapeutic exposure: an alkylating agent/radiation-related type and a topoisomerase II inhibitor-related type. Inter-individual variability in the risk for development of t-MDS/AML suggests a role for genetic variation in susceptibility to genotoxic exposures. Treatment of t-MDS/AML with conventional therapy is associated with a uniformly poor prognosis, with a median survival of 6 months. Because of the poor response to conventional chemotherapy, allogeneic HCT is recommended. Current research is focused on developing risk prediction and risk reduction strategies.
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Affiliation(s)
- Smita Bhatia
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA.
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Illidge TM, Mayes S, Pettengell R, Bates AT, Bayne M, Radford JA, Ryder WDJ, Le Gouill S, Jardin F, Tipping J, Zivanovic M, Kraeber-Bodere F, Bardies M, Bodet-Milin C, Malek E, Huglo D, Morschhauser F. Fractionated 90Y-Ibritumomab Tiuxetan Radioimmunotherapy As an Initial Therapy of Follicular Lymphoma: An International Phase II Study in Patients Requiring Treatment According to GELF/BNLI Criteria. J Clin Oncol 2014; 32:212-8. [DOI: 10.1200/jco.2013.50.3110] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose We report an international, multicenter phase II trial to evaluate the efficacy and toxicity of fractionated 90Y-ibritumomab tiuxetan (90Y-IT) as initial therapy of follicular lymphoma (FL). Patients and Methods A total of 74 patients, with a median age of 61 years (range, 28 to 80 years), were recruited requiring initial therapy by Groupe d'Etude des Lymphomes Folliculaires (GELF)/British National Lymphoma Investigation (BNLI) criteria. Among them, 78% had stage III-IV disease, 32% intermediate, and 44% high-risk (according to FL International Prognostic Index). Treatment consisted of two doses of 90Y-IT (11.1 MBq/kg) administered 8 to 12 weeks apart. Patients with more than 20% lymphoma infiltration of bone marrow (BM) received one infusion per week for 4 consecutive weeks of rituximab (375 mg/m2) and proceeded to fractionated radioimmunotherapy (RIT) only if a repeat BM biopsy demonstrated clearing of lymphoma to less than 20% involvement. The primary end point was end of treatment response of the intention-to-treat population. Secondary objectives were safety and progression-free survival (PFS). Results Initial overall response rate (ORR) was 94.4% (68 of 72 patients) with combined complete response (CR/CRu) of 58.3% (42 of 72 patients). Nine patients subsequently improved response making an ORR of 95.8% (69 of 72 patients) and CR/CRu of 69.4% (50 of 72 patients). At a median follow-up of 3.1 years (range, 0.2 to 5.2 years) estimated 3-year PFS is 58%, treatment-free survival 66%, and overall survival 95%. Median PFS is 40.2 months. Thirty patients have experienced disease progression and 24 have required further treatment. The treatment was well tolerated with few (2.8%) grade 3 or 4 infectious episodes or adverse events and manageable hematologic toxicity. Conclusion Fractionated RIT using 90Y-IT is an effective initial treatment for advanced-stage FL in patients with higher tumor burden requiring treatment.
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Affiliation(s)
- Tim M. Illidge
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Sam Mayes
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Ruth Pettengell
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Andrew T. Bates
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Mike Bayne
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - John A. Radford
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - W. David J. Ryder
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Steven Le Gouill
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Fabrice Jardin
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Jill Tipping
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Maureen Zivanovic
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Françoise Kraeber-Bodere
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Manuel Bardies
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Caroline Bodet-Milin
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Emmanuel Malek
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Damien Huglo
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
| | - Franck Morschhauser
- Tim M. Illidge, Sam Mayes, John A. Radford, W. David J. Ryder, Manchester Academic Health Science Centre, University of Manchester; Jill Tipping, Maureen Zivanovic, Christie Hospital NHS Foundation Trust, Manchester; Ruth Pettengell, St. George's, University of London, London; Andrew T. Bates, Southampton University Hospitals NHS Foundation Trust, Southampton; Mike Bayne, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Steven Le Gouill, Centre Hospitalier Universitaire Nantes; Françoise
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Akhtari M, Bhatt VR, Tandra PK, Krishnamurthy J, Horstman H, Dreessen A, Chen PX, Armitage JO. Therapy-related myeloid neoplasms after autologous hematopoietic stem cell transplantation in lymphoma patients. Cancer Biol Ther 2013; 14:1077-88. [PMID: 24025414 DOI: 10.4161/cbt.26342] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Lymphoma patients treated with autologous transplantation (ASCT) live an increasingly long life with the recent advancement in therapeutic modalities. This has resulted in an increase in the incidence of therapy-related myeloid neoplasms (t-MN), which is one of the leading causes of non-relapse mortality. Several observational studies have linked the development of t-MN after ASCT with the intensity and frequency of chemotherapy, particularly alkylating agents, use of total body irradiation (TBI), and peripheral blood progenitor cells. In addition, role of genetic factors is increasingly being identified. It is postulated that the use of chemotherapy prior to ASCT results in DNA damage of progenitor cells, mitochondrial dysfunction, and altered gene expression related to DNA repair, metabolism as well as hematopoietic regulation. Cytogenetic studies have shown the presence of abnormalities in the peripheral blood progenitor cells prior to ASCT. It is, therefore, likely that the reinfusion of peripheral blood progenitor cells, proliferative stress on infused progenitor cells during hematopoietic regeneration and associated telomere shortening ultimately result in clonal hematopoiesis and blastic transformation. Cytopenias, myelodysplasia, or cytogenetic abnormalities are common and can be transient after ASCT; therefore, only when present together, they do confirm the diagnosis of t-MN. Attempts to reduce the occurrence of t-MN should be directed toward minimizing the exposure to the identified risk factors. Although the median survival is few months to less than a year, studies have shown the promising role of allogeneic transplantation in select young t-MN patients without high-risk cytogenetics. In this review we will explain the recent findings in the field of t-MN in lymphoma patients that have implications for identifying the molecular and genetic mechanisms of leukemogenesis and discuss potential strategies to reduce the risk of t-MN in this patient population.
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Affiliation(s)
- Mojtaba Akhtari
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Vijaya Raj Bhatt
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Pavan Kumar Tandra
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Jairam Krishnamurthy
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Heidi Horstman
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Amy Dreessen
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - Pei Xian Chen
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
| | - James O Armitage
- Division of Hematology and Oncology; Department of Internal Medicine; University of Nebraska Medical Center; Omaha, NE USA
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Kharfan-Dabaja MA, Nishihori T, Otrock ZK, Haidar N, Mohty M, Hamadani M. Monoclonal antibodies in conditioning regimens for hematopoietic cell transplantation. Biol Blood Marrow Transplant 2013; 19:1288-300. [PMID: 23618718 DOI: 10.1016/j.bbmt.2013.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
Monoclonal antibodies are increasingly being incorporated in conditioning regimens for autologous or allogeneic hematopoietic cell transplantation (HCT). The benefit of adding rituximab to autologous HCT regimens is purportedly related to in vivo purging of clonal B cells. Randomized trials comparing the addition (or not) of rituximab to high-dose therapy regimens are lacking. No benefit of standard-dose radioimmunotherapy-based regimens for autografting in aggressive lymphomas was seen in a randomized controlled study. The incorporation of rituximab into allogeneic HCT regimens aims to improve responses while reducing nonrelapse mortality resulting from acute graft-versus-host disease. The optimal dose and administration schedule of rituximab in this setting are unknown, and potentially serious complications from increased infections owing to prolonged (and profound) cytopenias or persistent hypogammaglobulinemia are of concern. Radioimmunotherapy-based conditioning for allografting holds promise as a modality to optimize tumor control and synergize adoptive immunotherapy effects, but it remains experimental at this time. The addition of alemtuzumab to allogeneic HCT regimens is associated with prolonged lymphopenia and impaired immune reconstitution, high relapse rates, and serious infections. The optimal dose and schedule of alemtuzumab to avoid prolonged immune paresis remain elusive. It is anticipated that additional monoclonal antibodies will soon become available that can be incorporated into HCT regimens after safety and clinical efficacy are demonstrated.
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Affiliation(s)
- Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida 33612,
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What's all the fuss about? facts and figures about bone marrow failure and conditions. Curr Hematol Malig Rep 2013; 7:300-9. [PMID: 22936422 DOI: 10.1007/s11899-012-0134-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The epidemiology of bone marrow failure conditions is not well understood. Although several population-based studies conducted in the last two decades have generated a wealth of information, it is still very challenging to interpret disease incidence and prevalence, particularly due to changes in disease classification, misdiagnosis of patients, frequent underreporting and use of different referent populations to calculate rates. Despite these limitations, the available epidemiologic data have revealed significant ethnic, geographic and clinical differences in disease biology that have implications for prevention and treatment strategies. With advances made in targeted therapies facilitated by identification of molecular biomarkers and increased use of curative bone marrow transplantation approach, the natural history of these disease entities is already changing. The epidemiology of these diseases seems to be the next frontier as knowledge gained about the risk factors and pathobiologic correlates could significantly help in designing patient-specific therapies with improved outcomes.
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Deol A, Abrams J, Masood A, Al-Kadhimi Z, Abidi MH, Ayash L, Lum LG, Ratanatharathorn V, Uberti JP. Long-term follow up of patients proceeding to transplant using plerixafor mobilized stem cells and incidence of secondary myelodysplastic syndrome/AML. Bone Marrow Transplant 2013; 48:1112-6. [PMID: 23474805 DOI: 10.1038/bmt.2013.10] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/10/2013] [Accepted: 01/15/2013] [Indexed: 11/09/2022]
Abstract
We report the long-term follow up of 49 patients (pts) enrolled on plerixafor compassionate use protocol. Thirty-seven pts (76%) had failed one previous mobilization attempt, while 12 (24%) had failed two or more previous attempts. Using the combination of plerixafor and granulocyte colony-stimulating factor, we collected2.5 × 10(6) CD34+cells/kg in 33 pts (67%). Forty-three of the 49 pts proceeded to an auto-SCT (ASCT). The median days to WBC and platelet engraftment were 11 (range, 9-13 days) and 16 (range, 11-77 days) days post ASCT, respectively. The median WBC count, Hb and platelet counts 1 year after ASCT were 4.7 × 10(9)/L, 12.2 g/dL and 109 × 10(9)/L, respectively. With median follow up of 42 months (range <1-54 months), 21 pts had evidence of disease progression. Five pts developed myelodysplastic syndrome (MDS)/AML at median of 29 months post ASCT. The cumulative incidence of MDS/AML at 42 months was 17% (95% confidence interval, 6 to 32%). Development of secondary MDS/AML in pts proceeding to ASCT after plerixafor mobilization needs to be studied further in a larger cohort.
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Affiliation(s)
- A Deol
- Blood and Marrow SCT Program, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA.
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Subsequent malignant neoplasms after hematopoietic cell transplantation. Biol Blood Marrow Transplant 2012; 18:S139-50. [PMID: 22226098 DOI: 10.1016/j.bbmt.2011.10.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ban-Hoefen M, Kelly JL, Bernstein SH, Liesveld J, Constine L, Becker M, Milner L, Phillips G, Friedberg JW. High-dose therapy and autologous stem cell transplant for transformed non-Hodgkin lymphoma in the rituximab era. Leuk Lymphoma 2011; 53:830-5. [PMID: 22023518 DOI: 10.3109/10428194.2011.631637] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The impact of rituximab on the outcome of high-dose therapy and autologous stem cell transplant (HD-ASCT) for transformed non-Hodgkin lymphoma (NHL) has not been previously described. We analyzed 18 consecutive patients with indolent NHL who transformed to diffuse large B-cell lymphoma (DLBCL), received rituximab-containing therapy either before or after transformation and underwent subsequent HD-ASCT. With a median follow-up of 40 months, the 2-year progression-free survival (PFS) was 59% and the 2-year overall survival (OS) was 82%. Six patients did not receive rituximab pre-transformation. This group had a significantly better PFS at 2 years post-HD-ASCT compared to 12 patients who were exposed to rituximab pre-transformation (p = 0.03). HD-ASCT remains an effective therapeutic option for transformed NHL in the rituximab era. However, patients exposed to rituximab pre-transformation appear to have inferior HD-ASCT outcomes, and thus may benefit from novel conditioning and maintenance regimens in the setting of HD-ASCT.
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Affiliation(s)
- Makiko Ban-Hoefen
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY , USA
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Brion A, Mahé B, Kolb B, Audhuy B, Colombat P, Maisonneuve H, Foussard C, Bureau A, Ferrand C, Lesesve JF, Béné MC, Feugier P. Autologous transplantation in CLL patients with B and C Binet stages: final results of the prospective randomized GOELAMS LLC 98 trial. Bone Marrow Transplant 2011; 47:542-8. [DOI: 10.1038/bmt.2011.117] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Keung YK, Beaty MW, Pettenati M, Levitan D, Hurd DD. Possible role of engraftment syndrome and autologous graft-versus-host disease in myelodysplastic syndrome after autologous stem cell transplantations: retrospective analysis and review of the literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2010; 10:129-33. [PMID: 20371446 DOI: 10.3816/clml.2010.n.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND We report a retrospective study of 452 patients with lymphoma from 1991 to 2006, with 274 men and 178 women, median age of 50 years (range, 16-76 years). PATIENTS AND METHODS There were 85 patients with Hodgkin lymphoma (HL) and 367 with non-Hodgkin lymphoma (NHL). Eleven patients received a second autologous transplantation for progressive lymphoma, and another 4 received a second allogeneic transplantation for myelodysplastic syndrome (MDS). Twenty-seven patients had skin biopsies, and 2 patients had gastrointestinal biopsies consistent with graft-versus-host disease (GVHD), and 11 patients developed severe engraftment syndrome (ES), as defined by noninfectious fever and skin rash with or without pulmonary infiltrates requiring systemic steroids. RESULTS The median follow-up of the patients was 6.2 years, and median overall survival was 5.3 years. Twenty-four patients (5.3%) developed MDS with median time of onset of 4.2 years (range, 8 months to 7.5 years). An additional 5 patients developed clonal karyotypic abnormalities in the bone marrow without clinical MDS. Actuarial probabilities of developing MDS at 5 and 8 years after transplantation were 5% and 15%, respectively. CONCLUSION The incidences of MDS are similar in HL and NHL. Multivariate analysis revealed older age, occurrence of ES/GVHD, and longer intervals between the initial diagnoses to transplantation as independent factors. It is conceivable that perturbation to the host immunity caused by either previous chemotherapy or conditioning regimens in the elderly might play a role in the development of MDS after autologous transplantation.
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Affiliation(s)
- Yi-Kong Keung
- Section of Hematology-Oncology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Abstract
The incidence of the myelodysplastic syndromes (MDS) in the United States is reported as 3.4 per 100,000 people, translating to over 10,000 new diagnoses annually. This figure is considered to be an underestimate as our data capture techniques improve, and probably translates to a prevalence of approximately 60,000 people or more living with the disease. Patients are in their seventh or eighth decades at diagnosis, typically present with cytopenias, and have substantive transfusion requirements. The most common risk factors for developing MDS include advanced age, male gender, previous exposure to chemotherapy or radiation therapy, smoking, or, in rare cases, exposure to industrial chemicals.
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Affiliation(s)
- Mikkael A Sekeres
- Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Should the concern of myelodysplastic syndrome affect the decision of auto-SCT in lymphoma? Bone Marrow Transplant 2009; 45:407-8. [PMID: 19633689 DOI: 10.1038/bmt.2009.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ou JJ, Bagg A. Diagnostic challenges in the myelodysplastic syndromes: the current and future role of genetic and immunophenotypic studies. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2009; 3:275-91. [PMID: 23488463 DOI: 10.1517/17530050902813947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Myelodysplastic syndromes (MDS) comprise a clinically and pathologically diverse collection of hematopoietic neoplasms, most commonly presenting with peripheral cytopenias typically in the context of bone marrow hypercellularity. Mechanistically, at least in the early phases of the disease, this apparently paradoxical picture is primarily due to ineffective hematopoiesis, which is accompanied by a variety of morphologic abnormalities in hematopoietic cells. The identification of recurrent, clinically relevant cytogenetic defects in MDS has spurred the research of molecular mechanisms that contribute to its inception as well as to the development of heterogeneous subtypes. Although conventional cytogenetic analyses remain a diagnostic mainstay in MDS, the application of contemporary techniques including molecular cytogenetics, microarray technologies and multiparametric flow cytometry may ultimately reveal new diagnostic parameters that are theoretically more objective and sensitive than current morphologic approaches. This review aims to outline the role of genetic and immunophenotypic studies in the evaluation of MDS, including findings that may potentially influence future diagnostic classifications, which could refine prognostication and ultimately facilitate the growth of targeted therapies.
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Affiliation(s)
- Joyce J Ou
- University of Pennsylvania, Department of Pathology and Laboratory Medicine, 3400 Spruce Street, 6 Founders Pavilion, PA 19406-4283, USA
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Chakraborty S, Sun CL, Francisco L, Sabado M, Li L, Chang KL, Forman S, Bhatia S, Bhatia R. Accelerated telomere shortening precedes development of therapy-related myelodysplasia or acute myelogenous leukemia after autologous transplantation for lymphoma. J Clin Oncol 2009; 27:791-8. [PMID: 19124806 DOI: 10.1200/jco.2008.17.1033] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Therapy-related myelodysplasia or acute myelogenous leukemia (t-MDS/AML) is a lethal complication of autologous hematopoietic stem-cell transplantation (aHCT) for Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). Here, we investigated the hypothesis that accelerated telomere shortening after aHCT could contribute to the development of t-MDS/AML. PATIENTS AND METHODS A prospective longitudinal cohort was constructed to investigate the sequence of cellular and molecular abnormalities leading to development of t-MDS/AML after aHCT for HL/NHL. This cohort formed the sampling frame for a nested case-control study to compare changes in telomere length in serial blood samples from patients who developed t-MDS/AML with matched controls who did not develop t-MDS/AML. RESULTS An initial increase in telomere length at day 100 after aHCT was followed by an accelerated telomere shortening in t-MDS/AML patients when compared with controls. These telomere alterations preceded the onset of t-MDS and were independent of other known risk factors associated with development of t-MDS/AML on multivariate analysis. Additionally, we observed reduced generation of committed progenitors in patients who developed t-MDS/AML, indicating that these telomere alterations were associated with reduced regenerative capacity of hematopoietic stem cells. CONCLUSION The development of t-MDS/AML after aHCT is associated with and preceded by markedly altered telomere dynamics in hematopoietic cells. Accelerated telomere loss in patients developing t-MDS/AML may reflect increased clonal proliferation and/or altered telomere regulation in premalignant cells. Genetic instability associated with shortened telomeres may contribute to leukemic transformation in t-MDS/AML.
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Affiliation(s)
- Sujata Chakraborty
- Department of Stem Cell and Leukemia Research, Division of Population Sciences, City of Hope National Medical Center, Duarte, CA 91010, USA
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Abstract
Despite more effective front-line regimens, a substantial portion of patients with diffuse large B-cell lymphoma relapse and require further therapy. Several trials have established the efficacy of autologous stem cell transplantation for relapsed diffuse large B-cell lymphomas, but the benefit has been largely restricted to patients with chemosensitive disease and low-risk features at the time of relapse. In an effort to improve outcomes following an autologous transplant, researchers are exploring several avenues, including improvement of salvage regimens, addition of radioimmunotherapy to preparative regimens, and application of posttransplant treatments to eliminate minimal residual disease. Allogeneic stem cell transplantation also appears promising, but there is much to learn about optimal patient selection and timing. This review outlines the current approach to the management of relapsed diffuse large B-cell lymphoma, with an emphasis on newer peritransplant therapies.
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Prolonged haematological toxicity from the hyper-CVAD regimen: manifestations, frequency, and natural history in a cohort of 125 consecutive patients. Ann Hematol 2008; 87:727-34. [PMID: 18401583 DOI: 10.1007/s00277-008-0488-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 03/13/2008] [Indexed: 10/22/2022]
Abstract
The hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone (hyper-CVAD) regimen has impressive efficacy in several haematological malignancies but is associated with considerable short-term haematological toxicity. Secondary myelodysplasia (MDS) or acute myeloid leukaemia (AML) also occurs. In this retrospective study, we also describe other prolonged haematological sequelae of this regimen. One hundred and twenty-five patients were treated with a median of six hyper-CVAD cycles and followed for a median of 28 months. Follow-up for cytopenias was censored at the next cytotoxic therapy. At 3 months post-therapy, 77 patients were evaluable. Cytopenias persisted in 59% of patients. Requirement for dose attenuation was the only factor significantly associated with persisting cytopenias (p<0.05). The median time to normalisation of counts for those with post-treatment cytopenias in the respective lineages was 9 months (range, 6-12) for anaemia, 6 months (range, 6-30) for neutropenia and 9 months (range, 6-30) for thrombocytopenia. MDS/AML was diagnosed in four patients at 4, 21, 24 and 37 months after therapy with a cumulative incidence rate of 4.43% at 4 years. These results indicate a considerable rate of prolonged haematological toxicity after hyper-CVAD and a modest rate of MDS at this limited follow-up. These findings likely reflect cumulative damage to haematopoietic stem cells.
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Affiliation(s)
- Jonathan W Friedberg
- University of Rochester Medical Center, James P. Wilmot Cancer Center, Lymphoma Program 601 Elmwood Avenue, Box 704 Rochester, NY 14642, USA
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Friedberg JW, Cohen P, Chen L, Robinson KS, Forero-Torres A, La Casce AS, Fayad LE, Bessudo A, Camacho ES, Williams ME, van der Jagt RH, Oliver JW, Cheson BD. Bendamustine in Patients With Rituximab-Refractory Indolent and Transformed Non-Hodgkin's Lymphoma: Results From a Phase II Multicenter, Single-Agent Study. J Clin Oncol 2008; 26:204-10. [DOI: 10.1200/jco.2007.12.5070] [Citation(s) in RCA: 240] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeBendamustine hydrochloride is an alkylating agent with novel mechanisms of action. This phase II multicenter study evaluated the efficacy and toxicity of bendamustine in patients with B-cell non-Hodgkin's lymphoma (NHL) refractory to rituximab.Patients and MethodsPatients received bendamustine 120 mg/m2intravenously on days 1 and 2 of each 21-day cycle. Outcomes included response, duration of response, progression-free survival, and safety.ResultsSeventy-six patients, ages 38 to 84 years, with predominantly stage III/IV indolent (80%) or transformed (20%) disease were treated; 74 were assessable for response. Twenty-four (32%) were refractory to chemotherapy. Patients received a median of two prior unique regimens. An overall response rate of 77% (15% complete response, 19% unconfirmed complete response, and 43% partial) was observed. The median duration of response was 6.7 months (95% CI, 5.1 to 9.9 months), 9.0 months (95% CI, 5.8 to 16.7) for patients with indolent disease, and 2.3 months (95% CI, 1.7 to 5.1) for those with transformed disease. Thirty-six percent of these responses exceeded 1 year. The most frequent nonhematologic adverse events included nausea and vomiting, fatigue, constipation, anorexia, fever, cough, and diarrhea. Grade 3 or 4 reversible hematologic toxicities included neutropenia (54%), thrombocytopenia (25%), and anemia (12%).ConclusionSingle-agent bendamustine produced durable objective responses with acceptable toxicity in heavily pretreated patients with rituximab-refractory, indolent NHL. These findings are promising and will serve as a benchmark for future clinical trials in this novel patient population.
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Affiliation(s)
- Jonathan W. Friedberg
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Philip Cohen
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Ling Chen
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - K. Sue Robinson
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Andres Forero-Torres
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Ann S. La Casce
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Luis E. Fayad
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Alberto Bessudo
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Elber S. Camacho
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Michael E. Williams
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Richard H. van der Jagt
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Jennifer W. Oliver
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
| | - Bruce D. Cheson
- From the Wilmot Cancer Center, University of Rochester, Rochester, NY; Georgetown University Hospital, Washington, DC; Cephalon Inc, Frazer, PA; QE II Health Sciences Centre, Halifax, Nova Scotia; Ottawa Hospital, Ottawa, Ontario, Canada; University of Alabama, Birmingham, AL; Dana-Farber Cancer Institute, Boston, MA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; San Diego Cancer Center, San Diego; Desert Regional Med Center, Palm Springs, CA; and University of Virginia,
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Laurenti L, Tarnani M, Chiusolo P, Torre GL, Garzia M, Zollino M, Zini G, Balducci M, Leone G, Sica S. Low incidence of secondary neoplasia after autotransplantation for lymphoproliferative disease: the role of pre-transplant therapy. Clin Transplant 2007; 22:191-9. [DOI: 10.1111/j.1399-0012.2007.00768.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Przepiorka D, Buadi F, McClune B, Franz G, Walsh W, White F. Myelodysplastic syndrome after autologous peripheral blood stem cell transplantation for multiple myeloma. Bone Marrow Transplant 2007; 40:759-64. [PMID: 17680015 DOI: 10.1038/sj.bmt.1705814] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Long-term survivors after autologous peripheral blood stem cell transplantation (APBSCT) for lymphoma or Hodgkin's disease are known to have a high risk of developing myelodysplastic syndrome (MDS), but the risk of MDS is not clear for patients transplanted for myeloma. We reviewed the outcomes for 82 myeloma patients who underwent APBSCT at our center. The group included 47 men and 35 women of median age 56 years (range: 37-74 years). Median time from diagnosis to APBSCT was 8.2 months (range: 2.6-86.1 months). Before coming to transplantation, 28% had received oral melphalan (MEL), 98% received other chemotherapy and 34% received radiation. A single APBSCT was provided for 68, and 32% underwent APBSCT more than once. High-dose MEL alone was used as the preparative regimen for 83%, and the remainder received at least one APBSCT with a more intensive preparative regimen. Ten patients (12%) developed MDS. The 5-year cumulative incidence is 18% (95% confidence interval, 9-30%). There were no demographic factors associated with an increased risk of developing MDS. Median survival after the diagnosis of MDS was 18 months. There is a relatively high risk of MDS after APBSCT for myeloma, and optimal therapy has not been established for these patients.
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Affiliation(s)
- D Przepiorka
- University of Tennessee Blood and Marrow Transplant Center, Memphis, TN 38104, USA.
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Montoto S, Canals C, Rohatiner AZS, Taghipour G, Sureda A, Schmitz N, Gisselbrecht C, Fouillard L, Milpied N, Haioun C, Slavin S, Conde E, Fruchart C, Ferrant A, Leblond V, Tilly H, Lister TA, Goldstone AH. Long-term follow-up of high-dose treatment with autologous haematopoietic progenitor cell support in 693 patients with follicular lymphoma: an EBMT registry study. Leukemia 2007; 21:2324-31. [PMID: 17637813 DOI: 10.1038/sj.leu.2404850] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To evaluate the outcome of a large series of patients who received high-dose treatment (HDT) for follicular lymphoma (FL), 693 patients undergoing HDT (total-body irradiation (TBI)-containing regimen: 58%; autologous bone marrow (BM)/peripheral blood progenitor cells (PBPCs): 378/285 patients) were included in the study. A total of 375 patients (54%) developed recurrent lymphoma, 10-year progression-free survival (PFS) being 31%. On multivariate analysis, younger age (P=0.003) and HDT in first complete remission (CR1) (P<0.001) correlated with longer PFS. With a median follow-up of 10.3 years, 330 patients died. Ten-year overall survival (OS) from HDT was 52%. Shorter OS was associated on multivariate analysis with older age (P<0.001), chemoresistant disease (P<0.001), BM+PBPC as source of stem cells (P=0.007) and TBI-containing regimens (P=0.004). Thirty-nine patients developed secondary myelodysplastic syndrome/acute myeloid leukaemia (MDS/AML), in 34 cases having received TBI as the conditioning regimen. The 5-year non-relapse mortality (NRM) was 9%. On multivariate analysis, older age (P<0.001), refractory disease (P<0.001) and TBI (P=0.04) were associated with a higher NRM. This long follow-up study shows a plateau in the PFS curve, suggesting that a selected group of patients might be cured with HDT. On the downside, TBI-containing regimens are associated with a negative impact on survival.
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Affiliation(s)
- S Montoto
- Cancer Research UK Medical Oncology Unit, Institute of Cancer, Centre for Medical Oncology, Barts and the London, Queen Mary's School of Medicine and Dentistry, London, UK.
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