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Niederwieser C, Kröger N. Hematopoietic cell transplantation (HCT) in MDS patients of older age. Leuk Lymphoma 2024:1-15. [PMID: 38315612 DOI: 10.1080/10428194.2024.2307444] [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: 11/23/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
Hematopoietic cell transplantation (HCT) has evolved to an essential treatment in younger and more recently in elderly patients with myelodysplastic syndrome (MDS), the age group with the highest incidence. Less intense conditioning regimens and improvements in supportive therapy have reduced considerably transplant related mortality and in the same time increased the access to this curative treatment. Timing of HCT in the course of the disease assumes a crucial role. Detection of disease progression, geriatric assessment, comorbidity evaluation, and identification of transplant-specific risks are becoming increasingly important in this context. Novel statistical methods, molecular biomarkers, and quantification of tumor burden pre- and post-HCT will play an essential role in years to come. More effective and less toxic treatments to reduce the tumor burden before and/or after HCT are expected to improve the outcome. In this review article we discuss the current views and what we can expect.
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Affiliation(s)
- Christian Niederwieser
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Old age: the crown of life, our play's last act. Question and answers on older patients undergoing allogeneic hematopoietic cell transplantation. Curr Opin Hematol 2023; 30:14-21. [PMID: 36539361 DOI: 10.1097/moh.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Several studies showed that age alone should not be used as an arbitrary parameter to exclude patients from allogeneic hematopoietic cell transplantation (HCT). The accessibility to allogeneic HCT programs for older patients with hematological diseases is growing up constantly. The Center for International Blood and Marrow Transplant Research has recently shown that over 30% of allogeneic HCT recipients are at least 60 years old and that nearly 4% are aged 70 or more. Historically, the use of allogeneic HCT among elderly patients has been limited by age restrictions, reflecting physicians' concerns regarding prohibitive transplant-related mortality and HCT-associated morbidity. RECENT FINDINGS The introduction of reduced intensity/toxicity conditioning regimens has allowed transplant Centers to carry out allogeneic HCT on patients previously considered not ideal candidates. The integration of specific risk scores could lead to better capture mental and physical frailties of older patients. Older adults less frequently have available medically fit siblings, able to donate, so, unrelated donors, familial haploidentical donors or umbilical cord blood grafts could potentially abrogate such a difficulty, allowing the curative potential of allogeneic HCT. SUMMARY The appropriate assessing of allogeneic HCT feasibility for elderly patients should be the resonate application of different clinical and biological principles.
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Outcomes of older patients with diffuse large B-cell lymphoma treated with R-CHOP: 10-year follow-up of the LNH03-6B trial. Blood Adv 2022; 6:6169-6179. [PMID: 35737565 PMCID: PMC9772793 DOI: 10.1182/bloodadvances.2022007609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/09/2022] [Accepted: 06/12/2022] [Indexed: 12/30/2022] Open
Abstract
The LNH03-6B trial was a phase 3 randomized trial evaluating the efficacy of first-line rituximab, cyclophosphamide, doxorubicine, vincristine and prednisone (R-CHOP) delivered every 2 weeks (R-CHOP14) or 3 weeks (R-CHOP21) in patients with diffuse large B-cell lymphoma (DLBCL) aged 60 to 80 years with an aaIPI (age-adjusted International Prognostic Index) score ≥1 (registered as NCT00144755). We implemented a prospective long-term follow-up program at the end of this trial. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Relapse patterns, PFS and OS after the first progression (PFS2 and OS2) were secondary endpoints. LNH03-6B was registered with ClinicalTrials.gov #NCT00144755. In the LNH03-6B trial, 304 and 296 patients were assigned to receive 8 cycles of R-CHOP14 or R-CHOP21, respectively. Long-term follow-up data were investigated for 256 of 384 (67%) patients still alive at the primary analysis. With a median follow-up of 10.1 years, 213 patients progressed, and 140 patients died without progression. The 10-year PFS was 40.4% (95% confidence interval, 35.9-44.9). Ten-year OS was based on 302 deaths and estimated at 50% (43-56). Of the 213 patients, 105 (49%) progressed after second-line therapy, and 77 patients died without a second progression (36%). The 1-year PFS2 and 1-year OS2 were estimated at 37.9% (95% confidence interval, 31.4-44.5) and 55.8% (95% confidence interval, 48.8-62.2), respectively. Ten years after randomization, the outcomes of patients treated for DLBCL were similar according to PFS and OS between the RCHOP-14 and R-CHOP21 groups. Progression or relapse led to poor prognosis after second-line chemotherapy in the pre CAR-T-cell era. Novel approaches in first-line and alternative treatments in second-line treatments are warranted in this population.
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Theranostic Potentials of Gold Nanomaterials in Hematological Malignancies. Cancers (Basel) 2022; 14:cancers14133047. [PMID: 35804818 PMCID: PMC9264814 DOI: 10.3390/cancers14133047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/03/2022] [Accepted: 06/17/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Hematological malignancies (HMs) cover 50% of all malignancies, and people of all ages can be affected by these deadly diseases. In many cases, conventional diagnostic tools fail to diagnose HMs at an early stage, due to heterogeneity and the long-term indolent phase of HMs. Therefore, many patients start their treatment at the late stage of HMs and have poor survival. Gold nanomaterials (GNMs) have shown promise as a cancer theranostic agent. GNMs are 1 nm to 100 nm materials having magnetic resonance and surface-plasmon-resonance properties. GNMs conjugated with antibodies, nucleic acids, peptides, photosensitizers, chemotherapeutic drugs, synthetic-drug candidates, bioactive compounds, and other theranostic biomolecules may enhance the efficacy and efficiency of both traditional and advanced theranostic approaches to combat HMs. Abstract Hematological malignancies (HMs) are a heterogeneous group of blood neoplasia generally characterized by abnormal blood-cell production. Detection of HMs-specific molecular biomarkers (e.g., surface antigens, nucleic acid, and proteomic biomarkers) is crucial in determining clinical states and monitoring disease progression. Early diagnosis of HMs, followed by an effective treatment, can remarkably extend overall survival of patients. However, traditional and advanced HMs’ diagnostic strategies still lack selectivity and sensitivity. More importantly, commercially available chemotherapeutic drugs are losing their efficacy due to adverse effects, and many patients develop resistance against these drugs. To overcome these limitations, the development of novel potent and reliable theranostic agents is urgently needed to diagnose and combat HMs at an early stage. Recently, gold nanomaterials (GNMs) have shown promise in the diagnosis and treatment of HMs. Magnetic resonance and the surface-plasmon-resonance properties of GNMs have made them a suitable candidate in the diagnosis of HMs via magnetic-resonance imaging and colorimetric or electrochemical sensing of cancer-specific biomarkers. Furthermore, GNMs-based photodynamic therapy, photothermal therapy, radiation therapy, and targeted drug delivery enhanced the selectivity and efficacy of anticancer drugs or drug candidates. Therefore, surface-tuned GNMs could be used as sensitive, reliable, and accurate early HMs, metastatic HMs, and MRD-detection tools, as well as selective, potent anticancer agents. However, GNMs may induce endothelial leakage to exacerbate cancer metastasis. Studies using clinical patient samples, patient-derived HMs models, or healthy-animal models could give a precise idea about their theranostic potential as well as biocompatibility. The present review will investigate the theranostic potential of vectorized GNMs in HMs and future challenges before clinical theranostic applications in HMs.
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Mahajan S, Aalhate M, Guru SK, Singh PK. Nanomedicine as a magic bullet for combating lymphoma. J Control Release 2022; 347:211-236. [PMID: 35533946 DOI: 10.1016/j.jconrel.2022.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
Hematological malignancy like lymphoma originates in lymph tissues and has a propensity to spread across other organs. Managing such tumors is challenging as conventional strategies like surgery and local treatment are not plausible options and there are high chances of relapse. The advent of novel targeted therapies and antibody-mediated treatments has proven revolutionary in the management of these tumors. Although these therapies have an added advantage of specificity in comparison to the traditional chemotherapy approach, such treatment alternatives suffer from the occurrence of drug resistance and dose-related toxicities. In past decades, nanomedicine has emerged as an excellent surrogate to increase the bioavailability of therapeutic moieties along with a reduction in toxicities of highly cytotoxic drugs. Nanotherapeutics achieve targeted delivery of the therapeutic agents into the malignant cells and also have the ability to carry genes and therapeutic proteins to the desired sites. Furthermore, nanomedicine has an edge in rendering personalized medicine as one type of lymphoma is pathologically different from others. In this review, we have highlighted various applications of nanotechnology-based delivery systems based on lipidic, polymeric and inorganic nanomaterials that address different targets for effectively tackling lymphomas. Moreover, we have discussed recent advances and therapies available exclusively for managing this malignancy.
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Affiliation(s)
- Srushti Mahajan
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India
| | - Mayur Aalhate
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India
| | - Santosh Kumar Guru
- Department of Biological Science, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India
| | - Pankaj Kumar Singh
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India.
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Outcomes of Autologous Hematopoietic Cell Transplantation in Older Patients with Diffuse Large B Cell Lymphoma. Transplant Cell Ther 2022; 28:487.e1-487.e7. [PMID: 35609865 PMCID: PMC9375438 DOI: 10.1016/j.jtct.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
Data for outcomes after autologous hematopoietic cell transplantation (auto-HCT) in diffuse large B-cell lymphoma (DLBCL) patients ≥70 years are limited. Auto-HCT is feasible in older DLBCL patients. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes of auto-HCT in DLBCL patients aged 60 to 69 years (n = 363) versus ≥70 years (n = 103) between 2008 and 2019. Non-relapse mortality (NRM), relapse/progression (REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models. All patients received BEAM conditioning (carmustine, etoposide, cytosine arabinoside and melphalan). On univariate analysis, in the 60 to 69 years versus ≥70 years cohorts, 100-day NRM was 3% versus 4%, 5-year REL was 47% versus 45%, 5-year PFS 40% versus 38% and 5-year OS 55% versus 41%, respectively. On multivariate analysis, patients ≥70 had no significant difference in NRM (hazard ratio [HR] 1.43, 95% confidence interval [CI] 0.85-2.39), REL (HR 1.11, 95% CI 0.79-1.56), PFS (HR 1.23, 95% CI 0.92-1.63) compared to patients 60 to 69 years. Patients ≥70 years had a higher mortality (HR 1.39, 95% CI 1.05-1.85, p=0.02), likely because of inferior post-relapse OS in this cohort (HR 1.82, 95% CI 1.27-2.61, P = .001). DLBCL was the major cause of death in both cohorts (62% versus 59%). Older patients should not be denied auto-HCT solely on the basis of chronological age.
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Rodrigues BC, Sales AEC, Rodrigues BC, Mendonça PDS. Avaliação do Letramento em Saúde em Pacientes com Câncer Hematológico Submetidos ao Transplante de Células-Tronco Hematopoiéticas. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n1.1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Introdução: Pacientes com câncer hematológico, candidatos a transplante de células-tronco hematopoiéticas (TCTH), requerem um autocuidado extenso, com tratamentos complexos e comportamentos de saúde adequados que são considerados fator-chave. Frente a essas complexidades, surge a importância do letramento em saúde. Objetivo: Descrever o nível de letramento e avaliar as inter-relações existentes entre letramento em saúde, estado nutricional, condições sociodemográficas e clínicas nos pacientes com câncer hematológicos e candidatos a TCTH em um hospital universitário terciário de Fortaleza-CE. Método: Estudo de caráter transversal realizado com 69 pacientes candidatos a TCHT, atendidos nesse hospital, que responderam à versão validada e traduzida do Newest Vital Sign (NVS-Br). Os dados clínicos e sociodemográficos foram coletados por meio da análise dos prontuários. O estado nutricional foi avaliado pelo índice de massa corporal (IMC), circunferência da cintura (CC) e CC associada à relação cintura-quadril (RCQ). Resultados: O letramento inadequado foi encontrado em 78,3% dos pacientes. Os fatores foram associados à idade (p=0,024), à baixa renda (p=0,005) e a menos anos de estudo (p=0,047). Conclusão: O estudo aponta para a necessidade de se melhorar o grau de letramento em saúde dos pacientes, a fim de obter melhores resultados no tratamento, principalmente naqueles que apresentam idade mais avançada, baixa renda e menor escolaridade.
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Koch LDOM, Pereira AZ, Hamerschlak N, Castro ADAE, Tachibana A, Victor EDS, Filho RJG. Influence of body composition assessed by computed tomography on mortality in older adults undergoing hematopoietic stem cell transplantation. Nutr Clin Pract 2022; 37:1400-1408. [PMID: 35085415 DOI: 10.1002/ncp.10808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The incidence of most hematologic malignancies increases with age. Hematopoietic stem cell transplantation (HSCT) provides a potentially life-prolonging or curative option for many patients in this scenario. Limited data assessed from computed tomography (CT) images are available on muscle mass and density outcomes after HSCT. We evaluate the influence of body composition on morbidity and mortality in older adults undergoing HSCT. METHODS Retrospective longitudinal study conducted with 50 patients ≥ 60 years old undergoing HSCT. Body composition was assessed by chest CT (CCT), and treatment-related mortality, graft-vs-host disease (GVHD), neutrophil grafting, and overall survival were analyzed. RESULTS 148 HSCT patients were evaluated; 50 patients were eligible: 60% with autologous and 40% with allogeneic transplantation. Body mass index in patients was (female: 26.9 ± 4.7 kg/m2 ; male: 30.1 ± 4.9 kg/m2 ) - autologous and, (female: 24.3 ± 5.1 kg/m2 ; male: 26.4 ± 2.0 kg/m2 ) - allogeneic. In the autologous group, we found a positive association between age and death risk, with 63.5% increased risk of death (P = 0.006), and also Karnofsky Performance Score, with a 11.9% decrease in death risk (P < 0.001). A negative association between muscle radiodensity and death risk was observed in patients who received an allogeneic transplantation, with a risk decrease of 20.1% (P = 0.032). We found a positive association between the fourth thoracic vertebra muscle area and radiodensity and risk of acute GVHD (P = 0.028). CONCLUSION Body composition assessed by CCT showed the importance of radiodensity for better prognosis.
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Affiliation(s)
| | - Andrea Z Pereira
- Oncology and Hematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nelson Hamerschlak
- Oncology and Hematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Adham do Amaral E Castro
- Diagnostic and Preventive Medicine Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Adriano Tachibana
- Diagnostic and Preventive Medicine Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Teofili L, Bianchi M, Valentini CG, Bartolo M, Orlando N, Sica S. Validation plan of bone marrow collection, processing and distribution using the failure mode and effect analysis methodology: a technical report. Cytotherapy 2021; 24:356-364. [PMID: 34865960 DOI: 10.1016/j.jcyt.2021.10.005] [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: 08/10/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AIMS Bone marrow (BM) is commonly used in the pediatric and adult setting as a source of hematopoietic stem cells (HSCs). The standards of the Joint Accreditation Committee of the International Society for Cell & Gene Therapy & European Society for Blood and Marrow Transplantation (JACIE) include specific requirements regarding BM collection, processing and distribution. To run this process, each transplant team develops a series of JACIE-compliant procedures, customizing them with regard to local settings and paths. Moreover, JACIE standards require that transplant teams validate and periodically revise their procedures to keep the entire process under control. In this article, the authors describe the methodology adopted in our center to fulfill the aforementioned JACIE requirements. METHODS The authors developed a validation plan based on the failure mode and effect analysis (FMEA) methodology. According to the FMEA approach, the authors carefully revised activities and procedures connected to BM collection, processing and distribution at our institution. The entire process was initially divided into five main phases (assessment of donor eligibility, perioperative autologous blood donation, preparation of BM collection kit, BM harvesting and BM processing and distribution), comprising 17 subphases and 22 activities. RESULTS For each activity, one or more failure modes were identified, for a total of 28 failure modes, and a risk priority number (RPN) was then assigned to each failure mode. Although many procedures were validated, others were subjected to substantial changes according to the RPN rating. Moreover, specific indicators were identified for subsequent monitoring to contain the risk of failure of steps emerging as critical at FMEA. CONCLUSIONS This is the first study describing use of the FMEA methodology within an HSC transplant program. Shaping the risk analysis based on local experience may be a trustworthy tool for identifying critical issues, directing strict monitoring of critical steps or even amending connected procedures. Overall, the FMEA approach enabled the authors to improve our process, checking its consistency over time.
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Affiliation(s)
- Luciana Teofili
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Bianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Caterina Giovanna Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Martina Bartolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Nicoletta Orlando
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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Effect of family cohesion on symptom distress during hematopoietic stem cell transplantation. Support Care Cancer 2021; 30:1731-1737. [PMID: 34585301 DOI: 10.1007/s00520-021-06593-z] [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: 05/07/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Family may play an important role in hematopoietic stem cell transplantation (HSCT) recovery; however, little is known about the effect of family functioning on an individual's health. The purpose of this study was to examine the effect of family cohesion (family functioning) on the trajectory of HSCT recipients' symptom distress (symptom frequency and symptom bother) before, during, and after HSCT. METHODS Secondary analysis was conducted using data collected from178 individuals who underwent HSCT. Longitudinal parallel process (LPP) modeling was used to examine how family cohesion and HSCT-associated symptoms (symptom frequency and symptom bother) change over time, and how these longitudinal changes relate to each other. RESULTS The trajectory of family cohesion predicted the trajectories of HSCT-associated symptom frequency and bother. HSCT recipients who experienced higher family cohesion at baseline (T1) showed lower symptom frequency (p < .01) as well as symptom bother (p < .01) at T1. This trajectory analysis also showed that HSCT recipients who had improved family cohesion over time reported decrease in symptom frequency (p < .01) as well as bother (p < .01) over time. CONCLUSION Findings indicate that higher family cohesion predicts decrease in symptom distress over the HSCT trajectory. Interventions aimed at enhancing family cohesion have the potential to lower HSCT recipients' symptom distress. Further research is needed to understand the critical role of family cohesion and family functioning and their relationship with HSCT symptom distress prevention, early detection, and risk stratification.
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Ombres R, des Bordes JKA, Popat UR, Yennu S, Champlin RE, Mohile SG, Kebriaei P, Holmes HM. Serial frailty assessments following allogeneic stem cell transplant in older adults: A pilot study. J Geriatr Oncol 2021; 13:194-199. [PMID: 34493481 DOI: 10.1016/j.jgo.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/02/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Increasing numbers of older adults undergo allogeneic stem cell transplantation (SCT) as the only chance of meaningful survival for hematologic malignancies. However, toxicities in vulnerable patients may offset the benefits of SCT. Frailty and abnormal geriatric assessment (GA) prior to SCT have been associated with decreased overall survival in persons aged 60 and older. The purpose of this pilot study was to determine the prevalence of baseline GA deficits and frailty, the prevalence of frailty or death at three and six months after allogeneic SCT, and associations between baseline assessments and the presence of frailty or death post-SCT. METHODS We enrolled 50 patients aged 60 years and older and completed a baseline GA including comorbidity, polypharmacy, nutrition, physical performance, functional status, social support, depression and anxiety, and cognition. Frailty was defined as three or more abnormalities of gait speed, grip strength, weight loss, physical activity, and exhaustion, and was assessed at baseline, three months, and six months after SCT. A composite outcome of frailty or death at three months and six months was analyzed. RESULTS Frailty was present in 11/50 (22%) of patients at baseline. Ten patients did not complete three- month follow-up, and twelve patients did not complete six-month follow-up. Of those with follow-up data, 22 patients (55%) were frail or deceased three months after SCT, and 27 patients (71%) were frail or deceased six months after SCT. Frailty at baseline was not significantly associated with frailty or death at three or six months after SCT. However, the study's small enrollment limits conclusions on these associations. CONCLUSION GA deficits and frailty are prevalent in older adult SCT recipients at baseline and after transplant. Future studies should aim for larger enrollment in order to validate associations between these deficits and outcomes, especially survival, functional status, and quality of life following SCT.
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Affiliation(s)
- Rachel Ombres
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Jude K A des Bordes
- Department of Family Medicine, McGovern Medical School, Houston, TX, United States of America
| | - Uday R Popat
- Department of Stem Cell Transplant and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Sriram Yennu
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Richard E Champlin
- Department of Stem Cell Transplant and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Supriya G Mohile
- James Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Partow Kebriaei
- Department of Stem Cell Transplant and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, McGovern Medical School, Houston, TX, United States of America
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Outpatient hematopoietic cell transplantation for older adults with hematologic malignancies: Results at an academic tertiary-care center. J Geriatr Oncol 2021; 13:190-193. [PMID: 34465556 DOI: 10.1016/j.jgo.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/28/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022]
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13
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Kobe H, Arita M, Maeda T, Nagata O, Niwa T, Tokioka F, Ishida T. Acute Pulmonary Graft-Versus-Host Disease in a Patient with Adult T-cell Leukemia-Lymphoma Diagnosed by a Cryobiopsy. Intern Med 2021; 60:2269-2273. [PMID: 33583892 PMCID: PMC8355406 DOI: 10.2169/internalmedicine.6358-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 51-year-old woman with adult T-cell leukemia-lymphoma was hospitalized in order to undergo allogeneic hematopoietic stem-cell transplantation. On day 29 after transplantation, she began to experience hypoxia upon exertion. Chest computed tomography revealed centrilobular granular shadows, and pulmonary function tests revealed a remarkable obstructive ventilatory impairment compared to before transplantation. A histopathological analysis following a transbronchial lung cryobiopsy revealed acute graft-versus-host disease (GVHD). We herein report a rare case of histopathologically diagnosed acute pulmonary GVHD with spontaneous remission.
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Affiliation(s)
- Hiroshi Kobe
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Machiko Arita
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Takeshi Maeda
- Department of Hematology/Oncology, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Osamu Nagata
- Department of Hematology/Oncology, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Takashi Niwa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Fumiaki Tokioka
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
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Toxicities of high-dose chemotherapy and autologous hematopoietic cell transplantation in older patients with lymphoma. Blood Adv 2021; 5:2608-2618. [PMID: 34152404 DOI: 10.1182/bloodadvances.2020004167] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/30/2021] [Indexed: 01/04/2023] Open
Abstract
High-dose chemotherapy and autologous hematopoietic cell transplantation is an effective consolidation therapy in lymphoma; however, its use in elderly patients has been limited because of concerns for greater toxicity in this group. We investigated the toxicities of carmustine, etoposide, cytarabine, and melphalan (BEAM) and autologous hematopoietic cell transplantation (AHCT) in 346 patients in 2 age groups: 279 patients aged 60 to 69 years and 67 patients aged ≥70 years. The majority developed severe toxicities; the most common were febrile neutropenia, gastrointestinal, infections, and cardiovascular. Older patients were at higher risk for grade ≥3 cardiovascular toxicities (hazard ratio [HR], 3.36; 95% confidence interval [CI], 2.25-5.00; P < .001) and skin toxicities (HR, 2.45; 95% CI, 1.08-5.54, P = .032). In the older group, nonrelapse mortality at 100 days and at 2 years was 2.99% (95% CI, 0.55-9.32) and 6.2% (95% CI, 1.97-13.95), respectively, vs 1.79% (95% CI, 0.68-3.92) and 2.91% (95% CI, 1.37-5.42), respectively, in the younger group. When adjusting for the number of grade ≥3 toxicities within the first 100 days, older patients had a 1.71-fold (95% CI, 1.08-2.71) increased risk for progression or death relative to younger patients. Although BEAM followed by AHCT is effective, it is associated with significant organ toxicities, especially in patients aged ≥70 years. Interventions to mitigate toxicities while maintaining efficacy are much needed.
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15
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Wang SM, Park SS, Park SH, Kim NY, Kang DW, Na HR, Bae YY, Lee JW, Han S, Lim HK. Pre-transplant Dementia is Associated with Poor Survival After Hematopoietic Stem Cell Transplantation: A Nationwide Cohort Study with Propensity Score Matched Control. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:294-302. [PMID: 33888658 PMCID: PMC8077055 DOI: 10.9758/cpn.2021.19.2.294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/14/2020] [Accepted: 10/26/2020] [Indexed: 01/07/2023]
Abstract
Objective No previous study examined impact of dementia in the outcome of allogeneic hematopoietic stem cell transplantation (HSCT). We aimed to investigate overall survival (OS) of patients with dementia after receiving HSCT. Methods Among 8,230 patients who underwent HSCT between 2002 and 2018, 5,533 patients younger than 50 years were first excluded. Remaining patients were divided into those who were and were not diagnosed with dementia before HSCT (dementia group n = 31; no dementia n = 2,666). Thereafter, among 2,666 participants without dementia, 93 patients were selected via propensity-matched score as non-dementia group. Patients were followed from the day they received HSCT to the occurrence of death or the last follow-up day (December 31, 2018), whichever came first. Results With median follow-up of 621 days for dementia group and 654 days for non-dementia group, 2 year-OS of dementia group was lower than that of non-dementia group (53.3% [95% confidence interval, 95% CI, 59.0−80.2%] vs. 68.8% [95% CI, 38.0−68.2%], p = 0.076). In multivariate analysis, dementia had significant impacts on OS (hazard risk = 2.539, 95% CI, 1.166−4.771, p = 0.017). Conclusion Our results indicated that patients diagnosed with dementia before HSCT have 2.539 times higher risk of mortality after transplantation than those not having dementia. With number of elderly needing HSCT is increasing, further work to establish treatment guidelines for the management of HSCT in people with dementia is needed.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Soo Park
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - See Hyun Park
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nak-Young Kim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Woo Kang
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae-Ran Na
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Yi Bae
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Wook Lee
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seunghoon Han
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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16
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Sampaio MM, Santos MLC, Marques HS, Gonçalves VLDS, Araújo GRL, Lopes LW, Apolonio JS, Silva CS, Santos LKDS, Cuzzuol BR, Guimarães QES, Santos MN, de Brito BB, da Silva FAF, Oliveira MV, Souza CL, de Melo FF. Chronic myeloid leukemia-from the Philadelphia chromosome to specific target drugs: A literature review. World J Clin Oncol 2021; 12:69-94. [PMID: 33680875 PMCID: PMC7918527 DOI: 10.5306/wjco.v12.i2.69] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/22/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm and was the first neoplastic disease associated with a well-defined genotypic anomaly - the presence of the Philadelphia chromosome. The advances in cytogenetic and molecular assays are of great importance to the diagnosis, prognosis, treatment, and monitoring of CML. The discovery of the breakpoint cluster region (BCR)-Abelson murine leukemia (ABL) 1 fusion oncogene has revolutionized the treatment of CML patients by allowing the development of targeted drugs that inhibit the tyrosine kinase activity of the BCR-ABL oncoprotein. Tyrosine kinase inhibitors (known as TKIs) are the standard therapy for CML and greatly increase the survival rates, despite adverse effects and the odds of residual disease after discontinuation of treatment. As therapeutic alternatives, the subsequent TKIs lead to faster and deeper molecular remissions; however, with the emergence of resistance to these drugs, immunotherapy appears as an alternative, which may have a cure potential in these patients. Against this background, this article aims at providing an overview on CML clinical management and a summary on the main targeted drugs available in that context.
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Affiliation(s)
- Mariana Miranda Sampaio
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083-900, Bahia, Brazil
| | | | - Glauber Rocha Lima Araújo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Luana Weber Lopes
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Jonathan Santos Apolonio
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Camilo Santana Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Luana Kauany de Sá Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Beatriz Rocha Cuzzuol
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Mariana Novaes Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Cláudio Lima Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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17
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Abstract
Human lifespan is now longer than ever and, as a result, modern society is getting older. Despite that, the detailed mechanisms behind the ageing process and its impact on various tissues and organs remain obscure. In general, changes in DNA, RNA and protein structure throughout life impair their function. Haematopoietic ageing refers to the age-related changes affecting a haematopoietic system. Aged blood cells display different functional aberrations depending on their cell type, which might lead to the development of haematologic disorders, including leukaemias, anaemia or declining immunity. In contrast to traditional bulk assays, which are not suitable to dissect cell-to-cell variation, single-cell-level analysis provides unprecedented insight into the dynamics of age-associated changes in blood. In this Review, we summarise recent studies that dissect haematopoietic ageing at the single-cell level. We discuss what cellular changes occur during haematopoietic ageing at the genomic, transcriptomic, epigenomic and metabolomic level, and provide an overview of the benefits of investigating those changes with single-cell precision. We conclude by considering the potential clinical applications of single-cell techniques in geriatric haematology, focusing on the impact on haematopoietic stem cell transplantation in the elderly and infection studies, including recent COVID-19 research.
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Affiliation(s)
- Paulina M Strzelecka
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, 13353 Berlin, Germany
- German Consortium for Translational Cancer Research (DKTK), 69120 Heidelberg, Germany
| | - Frederik Damm
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, 13353 Berlin, Germany
- German Consortium for Translational Cancer Research (DKTK), 69120 Heidelberg, Germany
- Berlin Institute of Health, 10178 Berlin, Germany
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18
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Gawedzki P, Collins J. Impact of the implementation of a pharmacist-driven immunosuppression drug monitoring protocol for hematopoietic stem cell transplant recipients. J Oncol Pharm Pract 2020; 27:1907-1913. [PMID: 33250016 DOI: 10.1177/1078155220975088] [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] [Indexed: 11/16/2022]
Abstract
For patients with serious hematologic malignancies, hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment option. Majority of HSCT recipients receive tacrolimus as part of their immunosuppressive regimen. The purpose of this study is to evaluate the clinical impact of a pharmacist driven immunosuppression drug monitoring protocol for HSCT recipients on tacrolimus.This was a single-center, pre-post interventional study conducted at the University of Chicago Medical Center. Data collected via chart review includes the immunosuppressive agent used, interacting medications, adverse events, dose adjustments, drug concentrations, time to engraftment, and diagnosis of GVHD.Following the incorporation of a therapeutic drug monitoring protocol, the percentage of therapeutic tacrolimus levels was similar to when there was no protocol in place; 68% versus 64%, respectively (p = 0.34). There were 18 total adverse events observed in the pre-protocol group versus 10 in the post-protocol group (p = 0.03). Nephrotoxicity was the most common adverse event occurring in 23% of patients in the pre-protocol group and 15% of patients in the post-protocol group (p = 0.18). In the post-protocol group, there were 20 patients with two or more interacting drugs versus two patients in the pre-protocol group (p < 0.05). Additionally, the post-protocol group had 12 instances of an empiric dose adjustment made whereas the pre-protocol group had three instances (p = 0.006).Although there was no significant difference in percentage of therapeutic tacrolimus levels, pharmacist involvement resulted in improved safety outcomes such as management of drug interactions and incidence of adverse events.
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Affiliation(s)
- Paula Gawedzki
- Department of Pharmacy Services, 2462University of Chicago Medicine, Chicago, IL, USA
| | - Jennifer Collins
- Department of Pharmacy Services, 2462University of Chicago Medicine, Chicago, IL, USA
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19
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Pre-transplant depression decreased overall survival of patients receiving allogeneic hematopoietic stem cell transplantation: a nationwide cohort study. Sci Rep 2020; 10:15265. [PMID: 32943660 PMCID: PMC7499172 DOI: 10.1038/s41598-020-71208-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/30/2020] [Indexed: 12/27/2022] Open
Abstract
Studies investigating association of depression with overall survival (OS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) yielded conflicting results. A nationwide cohort study, which included all adult patients [n = 7,170; depression group, 13.3% (N = 956); non-depression group, 86.7% (N = 6,214)] who received allo-HSCT from 2002 to 2018 in South Korea, analyzed risk of pre-transplant depression in OS of allo-HSCT. Subjects were followed from the day they received allo-HSCT, to occurrence of death, or last follow-up day (December 31, 2018). Median age at allo-HSCT for depression and non-depression groups were 50 and 45 (p < 0.0001), respectively. Two groups also differed in rate of females (depression group, 55.8%; non-depression group, 43.8%; p < 0.0001) and leukemia (depression group, 61.4%; non-depression group, 49.7%; p < 0.0001). After a median follow-up of 29.1 months, 5-year OS rate was 63.1%. Cox proportional-hazard regression evaluated an adjusted risk of post-transplant mortality related to depression: OS decreased sequentially from no depression (adjusted hazard ratio [aHR] = 1) to pre-transplant depression only (aHR = 1.167, CI: 1.007–1.352, p = 0.04), and to having both depression and anxiety disorder (aHR = 1.202, CI: 1.038–1.393, p = 0.014) groups. Pre-transplant anxiety (anxiety only) did not have significant influence in OS. Additional medical and psychiatric care might be necessary in patients who experienced depression, especially with anxiety, before allo-HSCT.
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20
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Salas MQ, Chen S, Lam W, Pasic I, Gerbitz A, Michelis FV, Kim D(DH, Al-Shaibani Z, Lipton JH, Mattsson J, Kumar R, Viswabandya A, Law AD. Less Is More: Superior Graft-versus-Host Disease-Free/Relapse-Free Survival with Reduced-Intensity Conditioning and Dual T Cell Depletion in Acute Myelogenous Leukemia. Biol Blood Marrow Transplant 2020; 26:1511-1519. [DOI: 10.1016/j.bbmt.2020.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/16/2020] [Accepted: 04/18/2020] [Indexed: 01/22/2023]
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21
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Salas MQ, Atenafu EG, Bascom O, Wilson L, Lam W, Law AD, Pasic I, Kim DDH, Michelis FV, Al-Shaibani Z, Gerbitz A, Viswabandya A, Lipton JH, Mattsson J, Alibhai SMH, Kumar R. Pilot prospective study of Frailty and Functionality in routine clinical assessment in allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2020; 56:60-69. [PMID: 32606454 DOI: 10.1038/s41409-020-0979-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022]
Abstract
A Frailty and Functionality evaluation for alloHCT was implemented using existing resources. We describe the implementation of this evaluation across all ages and at first consultation, and correlate results with posttransplant outcomes in 168 patients. The evaluation consists of: Clinical Frailty Scale (CFS), Instrumental Activities of Daily Living (IADL), grip strength (GS), timed up and go test (TUGT), self-rated health question (SRH), Single question of Falls, albumin and C-Reactive Protein (CRP) levels. Median time to perform the evaluation was 5-6 min. Median age was 58 years (range: 19-77) and median follow-up was 5.3 months. TUGT > 10 s (HR 2.92; p = 0.003), raised CRP (HR 4.40; p < 0.001), and hypoalbuminemia (HR 2.10; p = 0.043) were significant risk factors for worse overal survival (OS). CFS ≥ 3 (HR 3.11; p = 0.009), TUGT > 10 s (HR 3.47; p = 0.003), GS (HR 2.56; p = 0.029), SRH (<excellent) (HR 3.8 × 106; p < 0.001), elevated CRP (HR 11.8; p < 0.001), and hypoalbuminemia (HR 4.6; p < 0.001), were significant predictors for worse non relapse mortality (NRM). On multivariable analysis, TUGT > 10 s and raised CRP were significant predictors for worse OS and NRM. SRH (<excellent) was a significant predictor for higher NRM. Frailty and Functionality can be assessed in routine clinical practice in alloHCT and may be predictive of short-term outcomes.
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Affiliation(s)
- Maria Queralt Salas
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Hematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, Barcelona, Spain
| | - Eshetu G Atenafu
- Department of Biostatistics, Princes Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ora Bascom
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Leeann Wilson
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wilson Lam
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Arjun Datt Law
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ivan Pasic
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Fotios V Michelis
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zeyad Al-Shaibani
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Armin Gerbitz
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Auro Viswabandya
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey Howard Lipton
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonas Mattsson
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Rajat Kumar
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada. .,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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22
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Graf SA, Samples LS, Keating TM, Garcia JM. Clinical research in older adults with hematologic malignancies: Opportunities for alignment in the Veterans Affairs. Semin Oncol 2020; 47:94-101. [PMID: 32327154 DOI: 10.1053/j.seminoncol.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of hematologic malignancies in older patients is complex and, with recent and anticipated trends in demographics, increasingly common. As a large, nationally integrated medical system the Veterans Affairs has the potential to lead in research to benefit these patients. In this review we describe the evolving treatment paradigms of hematologic malignancies and how they are best fit with older patients through comprehensive evaluation of key vulnerabilities. We also discuss optimization of supportive care and navigation services to target identified risks and challenges aimed at ameliorating the patient's burden of cancer and treatment. Lastly, we discuss opportunities in design of prospective clinical trials to better align with real-world cases, thereby expanding enrollment of and applicability to older patients with hematologic malignancies.
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Affiliation(s)
- Solomon A Graf
- Veterans Affairs Puget Sound Health Care System (VAPSHCS), Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Laura S Samples
- Division of Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Jose M Garcia
- Veterans Affairs Puget Sound Health Care System (VAPSHCS), Seattle, WA; VAPSHCS Geriatric Research and Education Clinical Center (GRECC), Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, WA
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23
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Kanate AS, Majhail NS, Savani BN, Bredeson C, Champlin RE, Crawford S, Giralt SA, LeMaistre CF, Marks DI, Omel JL, Orchard PJ, Palmer J, Saber W, Veys PA, Carpenter PA, Hamadani M. Indications for Hematopoietic Cell Transplantation and Immune Effector Cell Therapy: Guidelines from the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2020; 26:1247-1256. [PMID: 32165328 DOI: 10.1016/j.bbmt.2020.03.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022]
Abstract
The American Society for Transplantation and Cellular Therapy (ASTCT) published its first white paper on indications for autologous and allogeneic hematopoietic cell transplantation (HCT) in 2015. It was identified at the time that periodic updates of indications would be required to stay abreast with state of the art and emerging indications and therapy. In recent years the field has not only seen an improvement in transplantation technology, thus widening the therapeutic scope of HCT, but additionally a whole new treatment strategy using modified immune effector cells, including chimeric antigen receptor T cells and engineered T-cell receptors, has emerged. The guidelines review committee of the ASTCT deemed it optimal to update the ASTCT recommendations for indications for HCT to include new data and to incorporate indications for immune effector cell therapy (IECT) where appropriate. The guidelines committee established a multiple stakeholder task force consisting of transplant experts, payer representatives, and a patient advocate to provide guidance on indications for HCT and IECT. This article presents the updated recommendations from the ASTCT on indications for HCT and IECT. Indications for HCT/IECT were categorized as (1) Standard of care, where indication is well defined and supported by evidence; (2) Standard of care, clinical evidence available, where large clinical trials and observational studies are not available but have been shown to be effective therapy; (3) Standard of care, rare indication, for rare diseases where demonstrated effectiveness exists but large clinical trials and observational studies are not feasible; (4) Developmental, for diseases where preclinical and/or early-phase clinical studies show HCT/IECT to be a promising treatment option; and (5) Not generally recommended, where available evidence does not support the routine use of HCT/IECT. The ASTCT will continue to periodically review these guidelines and update them as new evidence becomes available.
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Affiliation(s)
- Abraham S Kanate
- Hematopoietic Malignancy & Cellular Therapy Program, West Virginia University, Morgantown, West Virginia.
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher Bredeson
- Division of Hematology, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - David I Marks
- Adult BMT Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Paul J Orchard
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Jeanne Palmer
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Wael Saber
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Paul A Veys
- Bone Marrow Transplantation Unit, Great Ormond Street Hospital for Children, London, UK
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
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24
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Amonoo HL, Kurukulasuriya C, Chilson K, Onstad L, Huffman JC, Lee SJ. Improving Quality of Life in Hematopoietic Stem Cell Transplantation Survivors Through a Positive Psychology Intervention. Biol Blood Marrow Transplant 2020; 26:1144-1153. [PMID: 32088365 DOI: 10.1016/j.bbmt.2020.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 12/13/2022]
Abstract
Despite advances in transplantation medicine, psychological distress and quality of life and functional deficits continue to compromise survivorship after hematopoietic stem cell transplantation (HSCT). With increasing numbers of HSCT survivors, supportive oncology interventions that target health-related outcomes in HSCT survivorship are needed. Here we aimed to test the feasibility and acceptability of a group format phone-delivered positive psychology (PP) intervention in HSCT survivors. This is a one-arm pilot study design that adapted and tested an individual PP intervention used in cardiac disease to a phone-delivered group-based program for HSCT survivors who were .4 to 39 years post-transplantation. All participants received an 8-session weekly PP intervention. We assessed feasibility by the enrollment and intervention completion rates. We examined acceptability on a 10-point Likert scale of ease and utility. Unstructured qualitative interviews were used to obtain participant feedback on the intervention for future application in a larger trial. Self-reported assessments on psychological, functional, and quality of life outcomes were administered at baseline and at follow-up (the end of the intervention). Of 64 eligible participants, 29 (45%) enrolled in the study. For the main aim of intervention feasibility and acceptability, participants completed 96% of all PP sessions and rated the ease (7.6 ± 1.7) and utility (8.1 ± 1.1) of sessions highly. Of the self-reported assessments obtained, the PP intervention resulted in improvements in the resilience scale (mean difference, 2.4 ± 5.4; P = .03). From unstructured qualitative interviews, participants reported the PP exercises and intervention helped them to focus on positive emotions and the group format fostered a sense of community and social support. An 8-week phone-delivered group format PP intervention is feasible and acceptable in HSCT survivors. The piloted intervention could be tested with minor modifications in a randomized study to definitively examine the impact of the group format PP intervention on health-related outcomes.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Kate Chilson
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Lynn Onstad
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston Massachusetts
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
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Graf SA, Samples LS, Keating TM, Garcia JM. Clinical research in older adults with hematologic malignancies: Opportunities for alignment in the Veterans Affairs. Semin Oncol 2019; 46:341-345. [PMID: 31606147 DOI: 10.1053/j.seminoncol.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022]
Abstract
Management of hematologic malignancies in older patients is complex and, with recent and anticipated trends in demographics, increasingly common. As a large, nationally integrated medical system the Veterans Affairs has the potential to lead in research to benefit these patients. In this review we describe the evolving treatment paradigms of hematologic malignancies and how they are best fit with older patients through comprehensive evaluation of key vulnerabilities. We also discuss optimization of supportive care and navigation services to target identified risks and challenges aimed at ameliorating the patient's burden of cancer and treatment. Lastly, we discuss opportunities in design of prospective clinical trials to better align with real-world cases, thereby expanding enrollment of and applicability to older patients with hematologic malignancies.
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Affiliation(s)
- Solomon A Graf
- Veterans Affairs Puget Sound Health Care System (VAPSHCS), Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Laura S Samples
- Division of Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Jose M Garcia
- Veterans Affairs Puget Sound Health Care System (VAPSHCS), Seattle, WA; VAPSHCS Geriatric Research and Education Clinical Center (GRECC), Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, WA
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Gonçalves SEAB, Ribeiro AAF, Hirose EY, Santos FPDS, Ferreira FM, Koch LDOM, Tanaka M, de Souza MS, Souza PMR, Gonçalves TJM, Pereira AZ. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly. EINSTEIN-SAO PAULO 2019; 17:eAE4340. [PMID: 31116236 PMCID: PMC6533077 DOI: 10.31744/einstein_journal/2019ae4340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly was elaborated by nutritionists, nutrologists and hematologists physicians from 15 Brazilians reference centers in hematopoietic stem cell transplantation, in order to emphasize the importancy of nutritional status and the body composition during the treatment, as well as the main characteristics related to patient's nutritional assessment. Establishing the consensus, we intended to improve and standardize the nutritional therapy during the hematopoietic stem cell transplantation. The Consensus was approved by the Brazilian Society of Bone Marrow Transplantation.
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Affiliation(s)
| | - Andreza Alice Feitosa Ribeiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Centro de Transplante de Medula Óssea, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Márcia Tanaka
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Psychological Considerations in Hematopoietic Stem Cell Transplantation. PSYCHOSOMATICS 2019; 60:331-342. [PMID: 31072626 DOI: 10.1016/j.psym.2019.02.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND In recent decades, advances in transplantation medicine, and improved posttransplant care have reduced morbidity and mortality from hematopoietic stem cell transplantations (HSCTs). However, patients undergoing HSCT report a high prevalence of psychological distress, which can negatively impact recovery, function, and health outcomes, including mortality and higher risk of graft vs. host disease. Appropriate assessment and management of these psychological symptoms lead to better engagement with treatment and a variety of superior health outcomes. OBJECTIVE We provide a narrative review of the psychological challenges that accompany HSCT and suggest management approaches to equip psychiatric consultants involved in the care of this patient population. METHODS We reviewed published work in PubMed, PsycInfo, and Scopus electronic databases on the common psychological challenges in HSCT, their vulnerability factors, as well as practical interventions for managing these challenges. RESULTS We outline the phases of the HSCT hospitalization and discuss common psychological challenges, such as depression, delirium, and post-traumatic stress reactions that accompany HSCT. We suggest an approach to psychiatric consults during the HSCT hospitalization and discuss practical interventions for managing psychological challenges in this population. CONCLUSIONS Though pharmacological and behavioral interventions have been successfully used to treat psychosocial challenges in HSCT, further research is needed to understand the optimal psychiatric assessment tools, treatment strategies, and the long-term psychiatric care needed to address psychiatric comorbidities in this growing patient population.
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Hematopoietic Cell Transplant (HCT) in the Elderly: Myths, Controversies and Unknowns. Drugs Aging 2019; 35:1055-1064. [PMID: 30302674 DOI: 10.1007/s40266-018-0596-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The incidence of most hematological malignancies increases with age. Despite the higher incidence of hematological malignancies in the elderly, the geriatric population is poorly represented in the early oncology clinical trials that established the current standards of care. Hematopoietic cell transplant (HCT), either upfront or at relapse, provides a potentially life-prolonging, often curative option for many patients with hematological malignancies and is considered the standard of care, at least for younger patients. Historically, the concern that older adults undergoing HCT may experience higher morbidity and transplant-related complications has limited the use of this potentially curative option to younger adults, particularly in allogeneic (allo-) HCT. There is growing evidence to support the feasibility, tolerability, and relatively similar effectiveness of both autologous and allo-HCT in the geriatric population. In the allo-HCT setting, nonmyeloablative/reduced-intensity conditioning (NMA/RIC) has expanded the spectrum of patients that can be considered for this approach. Overall survival is largely affected by disease stage, performance status, and comorbidities rather than by chronological age per se. Comprehensive geriatric assessment (CGA) is a promising tool that can uncover frequently undocumented vulnerabilities in an elderly transplant-eligible patient. Serial study of CGA throughout the peri-HCT period may help predict the short- and long-term impact of HCT on an older adult's functional status and quality of life. Further research is needed to evaluate whether early intervention to improve such vulnerabilities can improve survival and quality of life of these older patients.
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Stem Cell Transplantation and Physical Exercise in Parkinson's Disease, a Literature Review of Human and Animal Studies. Stem Cell Rev Rep 2018; 14:166-176. [PMID: 29270820 DOI: 10.1007/s12015-017-9798-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The absence of effective and satisfactory treatments that contribute to repairing the dopaminergic damage caused by Parkinson's Disease (PD) and the limited recovery capacity of the nervous system are troubling issues and the focus of many research and clinical domains. Recent advances in the treatment of PD through stem cell (SC) therapy have recognized their promising restorative and neuroprotective effects that are implicated in the potentiation of endogenous mechanisms of repair and contribute to functional locomotor improvement. Physical exercise (PE) has been considered an adjuvant intervention that by itself induces beneficial effects in patients and animal models with Parkinsonism. In this sense, the combination of both therapies could provide synergic or superior effects for motor recovery, in contrast with their individual use. This review aims to provide an update on recent progress and the potential effectiveness of SC transplantation and PE for the treatment of locomotor deficits in PD. It has reviewed the neuropathological pathways involved in the classical motor symptoms of this condition and the mechanisms of action described in experimental studies that are associated with locomotor enhancement through exercise, cellular transplantation, and their union in some neurodegenerative conditions.
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Pandrangi V, Reiter ER. The Burden of Sinusitis in Hematologic Transplant Patients: A National Perspective. Laryngoscope 2018; 128:2688-2692. [PMID: 30239988 DOI: 10.1002/lary.27363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the impact of sinusitis on outcomes of hematologic transplant procedures. STUDY DESIGN Retrospective analysis of a national hospital database. METHODS The National Inpatient Sample database for 2012 to 2013 was queried using International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify patients undergoing hematologic transplants. Patients were divided based upon the presence or absence of a concomitant diagnosis of acute or chronic sinusitis. Patient demographics, clinical characteristics, discharge results, lengths of stay (LOS), and costs were compared between groups. RESULTS There were 7,069 hematologic transplant cases identified, 2.7% of which had a diagnosis of sinusitis. Sinusitis patients had a longer LOS after transplant (24.9 ± 15.9 days vs. 19.1 ± 17.4 days, P < .001) and higher total hospital charges ($487,941 ± $447,532 vs. $322,300 ± $369,596, P < .001) than nonsinusitis patients. There was no difference in mortality between the two groups (P = .75). The 23 (12%) sinusitis patients who underwent sinus procedures had a longer LOS after transplant (34.8 ± 25 days vs. 23.5 ± 13.7 days, P = .001) and higher total hospital charges ($857,891 ± $718,456 vs. $437,293 ± $372,075, P < .001) than sinusitis patients without sinus procedures. Linear regression showed that sinusitis patients had excess LOS after transplant of 2.442 days and cost of $82,000.098. CONCLUSIONS This study demonstrates that presence of sinusitis in patients undergoing hematologic transplant is associated with increased LOS and higher total hospital charges. Increased focus on diagnosis and if possible treatment of sinusitis prior to admission for transplantation may help reduce the impact of sinusitis after hematologic transplant. LEVEL OF EVIDENCE NA Laryngoscope, 128:2688-2692, 2018.
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Affiliation(s)
- Vivek Pandrangi
- From the Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Evan R Reiter
- From the Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
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Zarrabi M, Afzal E, Ebrahimi M. Manipulation of Hematopoietic Stem Cell Fate by Small Molecule Compounds. Stem Cells Dev 2018; 27:1175-1190. [DOI: 10.1089/scd.2018.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Morteza Zarrabi
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Royan Stem Cell Technology Company, Cord Blood Bank, Tehran, Iran
| | - Elaheh Afzal
- Royan Stem Cell Technology Company, Cord Blood Bank, Tehran, Iran
| | - Marzieh Ebrahimi
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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Deshantri AK, Varela Moreira A, Ecker V, Mandhane SN, Schiffelers RM, Buchner M, Fens MHAM. Nanomedicines for the treatment of hematological malignancies. J Control Release 2018; 287:194-215. [PMID: 30165140 DOI: 10.1016/j.jconrel.2018.08.034] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 12/23/2022]
Abstract
Hematological malignancies (HM) are a collection of malignant transformations originating from cells in the primary or secondary lymphoid organs. Leukemia, lymphoma, and multiple myeloma comprise the three major types of HM. Current treatment consists of bone marrow transplantation, radiotherapy, immunotherapy and chemotherapy. Although, many chemotherapeutic drugs are clinically available for the treatment of HM, the use of these agents is limited due to dose-related toxicity and lack of specificity to tumor tissue. Moreover, the poor pharmacokinetic profile of most of the chemotherapeutics requires high dosage and frequent administration to maintain therapeutic levels at the target site, both increasing adverse effects. This underlines an urgent need for a suitable drug delivery system to improve efficacy, safety, and pharmacokinetic properties of conventional therapeutics. Nanomedicines have proven to enhance these properties for anticancer therapeutics. The most extensively studied nanomedicine systems are lipid-based nanoparticles and polymeric nanoparticles. Typically, nanomedicines are small sub-micron sized particles in the size range of 20-200 nm. The biocompatible and biodegradable nature of nanomedicines makes them attractive vehicles to improve drug delivery. Their small size allows them to extravasate and accumulate at malignant sites passively by means of the enhanced permeability and retention (EPR) effect, resulting from rapid angiogenesis and inflammation. Moreover, the specificity to the target tissue can be further enhanced by surface modification of nanoparticles. This review describes currently available therapies as well as limitations and potential advantages of nanomedicine formulations for treatment of various types of HM. Additionally, recent investigational and approved nanomedicine formulations and their limited applications in HM are discussed.
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Affiliation(s)
- Anil K Deshantri
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands; Biological Research Pharmacology Department, Sun Pharma Advanced Research Company Ltd, India
| | - Aida Varela Moreira
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Veronika Ecker
- Institute for Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Sanjay N Mandhane
- Biological Research Pharmacology Department, Sun Pharma Advanced Research Company Ltd, India
| | - Raymond M Schiffelers
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maike Buchner
- Institute for Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Marcel H A M Fens
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
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Goker H, Kelkitli E, Buyukasik Y, Demiroğlu H. Hematopoietic stem cell transplantation in geriatric patients in Turkey. Transfus Apher Sci 2018; 57:159-162. [PMID: 29753698 DOI: 10.1016/j.transci.2018.04.013] [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: 11/17/2022]
Abstract
The incidence of most hematologic malignancies increases with age. Physicians increasingly refer older patients for hematopoietic stem cell transplantation (HSCT) due to more experience and improved supportive care in HSCT. This article discusses the available data regarding the feasibility, tolerability, toxicity, and effectiveness of autologous and allogeneic HSCT in older adults.
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Affiliation(s)
- Hakan Goker
- Hacettepe University Medical School, Department of Hematology, Ankara, Turkey.
| | - Engin Kelkitli
- Ondokuz Mayis University Medical School, Department of Hematology, Samsun, Turkey
| | - Yahya Buyukasik
- Hacettepe University Medical School, Department of Hematology, Ankara, Turkey
| | - Haluk Demiroğlu
- Hacettepe University Medical School, Department of Hematology, Ankara, Turkey
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Hoogland AI, Nelson AM, Small BJ, Hyland KA, Gonzalez BD, Booth-Jones M, Anasetti C, Jacobsen PB, Jim HSL. The Role of Age in Neurocognitive Functioning among Adult Allogeneic Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 2017; 23:1974-1979. [PMID: 28797784 DOI: 10.1016/j.bbmt.2017.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/02/2017] [Indexed: 01/02/2023]
Abstract
Improvements in supportive care have enabled allogeneic hematopoietic cell transplantation (HCT) to be performed in increasingly older patients. HCT is associated with neurocognitive impairment, which may be exacerbated in older adults due to normal neurocognitive decline associated with aging. The goal of this study was to evaluate whether increasing age of allogeneic HCT recipients is associated with worse neurocognitive outcomes over time relative to a matched sample of individuals without cancer. Patients (n = 140; 42% female; M age, 51 years; range, 20 to 76 years; 31% with acute myelogenous leukemia) completed neurocognitive assessments before transplantation and 3 months and 1 year after transplantation. Controls (n = 75; 56% female; M age, 53 years; range, 21 to 74 years) completed assessments at comparable time intervals. Linear mixed models revealed that regardless of age, patients demonstrated worse performance than controls before transplantation in verbal memory, visual memory, and total neuropsychological performance, and over time in executive functioning. In addition, older age was associated with worse performance in verbal memory (P = .02) and verbal fluency (P = .05) over time in patients compared with controls. Specifically, older (65+ years) patients had worse verbal memory and verbal fluency than older and younger (<65 years) controls post-transplantation (Cohen's d = .22 to .39). These data indicate that age may be a risk factor for worse neurocognitive outcomes after allogeneic HCT. If replicated, our results suggest that older candidates for allogeneic HCT should be counseled regarding the risk of cognitive problems after transplantation.
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Affiliation(s)
- Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Ashley M Nelson
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, Florida
| | - Kelly A Hyland
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Margaret Booth-Jones
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Claudio Anasetti
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida.
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Rosko AE, Wang H, de Lima M, Sandmaier B, Khoury HJ, Artz A, Brammer J, Bredeson C, Farag S, Kharfan‐Dabaja M, Lazarus HM, Marks DI, Martino Bufarull R, McGuirk J, Mohty M, Nishihori T, Nivison‐Smith I, Rashidi A, Ringden O, Seftel M, Weisdorf D, Bachanova V, Saber W. Reduced intensity conditioned allograft yields favorable survival for older adults with B-cell acute lymphoblastic leukemia. Am J Hematol 2017; 92:42-49. [PMID: 27712033 DOI: 10.1002/ajh.24575] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 01/14/2023]
Abstract
Older adults with B-cell acute lymphoblastic leukemia (B-ALL) have poor survival. We examined the effectiveness of reduced intensity conditioning (RIC) hematopoietic cell transplant (HCT) in adults with B-ALL age 55 years and older and explored prognostic factors associated with long-term outcomes. Using CIBMTR registry data, we evaluated 273 patients (median age 61, range 55-72) with B-ALL with disease status in CR1 (71%), >CR2 (17%) and Primary Induction Failure (PIF)/Relapse (11%), who underwent RIC HCT between 2001 and 2012 using mostly unrelated donor (59%) or HLA-matched sibling (32%). Among patients with available cytogenetic data, the Philadelphia chromosome (Ph+) was present in 50%. The 3-year cumulative incidences of nonrelapse mortality (NRM) and relapse were 25% (95% confidence intervals (CI): 20-31%) and 47% (95% CI: 41-53%), respectively. Three-year overall survival (OS) was 38% (95% CI: 33-44%). Relapse remained the leading cause of death accounting for 49% of all deaths. In univariate analysis, 3 year risk of NRM was significantly higher with reduced Karnofsky performance status (KPS <90: 34% (95% CI: 25-43%) versus KPS ≥90 (18%; 95% CI: 12-24%, P = 0.006). Mortality was increased in older adults (66+ vs. 55-60: Relative Risk [RR] 1.51 95% CI: 1.00-2.29, P = 0.05) and those with advanced disease (RR 2.13; 95% CI: 1.36-3.34, P = 0.001). Survival of patients in CR1 yields 45% (95% CI: 38-52%) at 3 years and no relapse occurred after 2 years. We report promising OS and acceptable NRM using RIC HCT in older patients with B-ALL. Disease status in CR1 and good performance status are associated with improved outcomes. Am. J. Hematol. 92:42-49, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ashley E. Rosko
- Division of Hematology, Department of MedicineOhio State UniversityColumbus Ohio
| | - Hai‐Lin Wang
- Department of Medicine, Medical College of WisconsinCIBMTR, Center for International Blood and Marrow Transplant ResearchMilwaukee Wisconsin
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer CenterUniversity Hospitals Case Medical CenterCleveland Ohio
| | - Brenda Sandmaier
- Division of Medical OncologyUniversity of Washington and Clinical Research Division, Fred Hutchinson Cancer Research CenterSeattle Washington
| | | | - Andrew Artz
- Section of Hematology/OncologyUniversity of Chicago School of MedicineChicago Illinois
| | | | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research InstituteOttawa Ontario Canada
| | - Sherif Farag
- Indiana University Hospital/Riley Hospital for ChildrenIndianapolis Indianapolis
| | - Mohamed Kharfan‐Dabaja
- Department of Blood and Marrow TransplantationH. Lee Moffit Cancer Center and Research InstituteTampa Florida
| | - Hillard M. Lazarus
- Seidman Cancer CenterUniversity Hospitals Case Medical CenterCleveland Ohio
| | - David I. Marks
- Adult Bone Marrow TransplantUniversity Hospitals Bristol NHS TrustBristol United Kingdom
| | | | | | - Mohamed Mohty
- Hopital Saint‐AntoineAPHP, Universite Pierre & Marie Curie, INSERM UMRs U938Paris France
| | - Taiga Nishihori
- Department of Blood and Marrow TransplantationH. Lee Moffit Cancer Center and Research InstituteTampa Florida
| | | | | | - Olle Ringden
- Division of Therapeutic Immunology, Department of Laboratory MedicineKarolinska InstitutetStockholm Sweden
- Centre for Allogeneic Stem Cell TransplantationStockholm Sweden
| | - Matthew Seftel
- Department of Medical Oncology and HematologyPrincess Margaret Cancer CentreToronto Ontario Canada
| | - Daniel Weisdorf
- Divsion of Hematology, Oncology and Transplantation, Department of MedicineUniversity of Minnesota Medical CenterMinneapolis Minnesota
| | - Veronika Bachanova
- Bone and Marrow Transplant ProgramUniversity of Minnesota Medical CenterMinneapolis Minnesota
| | - Wael Saber
- Department of Medicine, Medical College of WisconsinCIBMTR, Center for International Blood and Marrow Transplant ResearchMilwaukee Wisconsin
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IL-10+ regulatory B cells are enriched in cord blood and may protect against cGVHD after cord blood transplantation. Blood 2016; 128:1346-61. [PMID: 27439912 DOI: 10.1182/blood-2016-01-695122] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 07/12/2016] [Indexed: 12/19/2022] Open
Abstract
Cord blood (CB) offers a number of advantages over other sources of hematopoietic stem cells, including a lower rate of chronic graft-versus-host disease (cGVHD) in the presence of increased HLA disparity. Recent research in experimental models of autoimmunity and in patients with autoimmune or alloimmune disorders has identified a functional group of interleukin-10 (IL-10)-producing regulatory B cells (Bregs) that negatively regulate T-cell immune responses. At present, however, there is no consensus on the phenotypic signature of Bregs, and their prevalence and functional characteristics in CB remain unclear. Here, we demonstrate that CB contains an abundance of B cells with immunoregulatory function. Bregs were identified in both the naive and transitional B-cell compartments and suppressed T-cell proliferation and effector function through IL-10 production as well as cell-to-cell contact involving CTLA-4. We further show that the suppressive capacity of CB-derived Bregs can be potentiated through CD40L signaling, suggesting that inflammatory environments may induce their function. Finally, there was robust recovery of IL-10-producing Bregs in patients after CB transplantation, to higher frequencies and absolute numbers than seen in the peripheral blood of healthy donors or in patients before transplant. The reconstituting Bregs showed strong in vitro suppressive activity against allogeneic CD4(+) T cells, but were deficient in patients with cGVHD. Together, these findings identify a rich source of Bregs and suggest a protective role for CB-derived Bregs against cGVHD development in CB recipients. This advance could propel the development of Breg-based strategies to prevent or ameliorate this posttransplant complication.
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Wildes TM, Campagnaro E. Management of multiple myeloma in older adults: Gaining ground with geriatric assessment. J Geriatr Oncol 2016; 8:1-7. [PMID: 27118356 DOI: 10.1016/j.jgo.2016.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/28/2015] [Accepted: 04/05/2016] [Indexed: 01/22/2023]
Abstract
Multiple myeloma increases in incidence with age. With the aging of the population, the number of cases of multiple myeloma diagnosed in older adults each year will nearly double in the next 20years. The novel therapeutic agents have significantly improved survival in older adults, but their outcomes remain poorer than in younger patients. Older adults may be more vulnerable to toxicity of therapy, resulting in decreased dose intensity and contributing to poorer outcomes. Data are beginning to emerge to aid in identifying which individuals are at greater risk for toxicity of therapy; comorbidities, functional limitations, and age over 80years are among the factors associated with greater risk. Geriatric assessment holds promise in the care of older adults with multiple myeloma, both to allow modification of treatment to prevent toxicity, and to identify vulnerabilities that may require intervention. Emerging treatments with low toxicity and attention to individualizing therapy based on geriatric assessment may aid in further improving outcomes in older adults with multiple myeloma.
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Affiliation(s)
- Tanya M Wildes
- Washington University School of Medicine, St. Louis, MO, USA.
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Blaes A, Konety S, Hurley P. Cardiovascular Complications of Hematopoietic Stem Cell Transplantation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:25. [PMID: 26909819 PMCID: PMC4766226 DOI: 10.1007/s11936-016-0447-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OPINION STATEMENT Survivors of hematopoietic stem cell transplant (HSCT) are at significant risk for cardiac disease and cardiac complications. While there may be cardiac complications during the acute period of HSCT, long-term survivors remain at risk for cardiovascular disease at a rate at least fourfold higher than the general population. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and arrhythmias is warranted pretransplant. For those with risk factors, particularly a history of cardiovascular disease or atrial fibrillation, cardiology consultation is warranted in the pretransplantation period. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and hyperlipidemia is warranted in HSCT survivors as well; early and aggressive treatment of left ventricular dysfunction is warranted. Collaboration between hematology/oncology and cardiology through a cardio-oncology clinic is an optimal way to help manage these patients.
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Affiliation(s)
- Anne Blaes
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.
| | - Suma Konety
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Peter Hurley
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
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Devine SM, Owzar K, Blum W, Mulkey F, Stone RM, Hsu JW, Champlin RE, Chen YB, Vij R, Slack J, Soiffer RJ, Larson RA, Shea TC, Hars V, Sibley AB, Giralt S, Carter S, Horowitz MM, Linker C, Alyea EP. Phase II Study of Allogeneic Transplantation for Older Patients With Acute Myeloid Leukemia in First Complete Remission Using a Reduced-Intensity Conditioning Regimen: Results From Cancer and Leukemia Group B 100103 (Alliance for Clinical Trials in Oncology)/Blood and Marrow Transplant Clinical Trial Network 0502. J Clin Oncol 2015; 33:4167-75. [PMID: 26527780 DOI: 10.1200/jco.2015.62.7273] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Long-term survival rates for older patients with newly diagnosed acute myeloid leukemia (AML) are extremely low. Previous observational studies suggest that allogeneic hematopoietic stem-cell transplantation (HSCT) may improve overall survival (OS) because of lower rates of relapse. We sought to prospectively determine the value of HSCT for older patients with AML in first complete remission. PATIENTS AND METHODS We conducted a prospective multicenter phase II study to assess the efficacy of reduced-intensity conditioning HSCT for patients between the ages of 60 and 74 years with AML in first complete remission. The primary end point was disease-free survival at 2 years after HSCT. Secondary end points included nonrelapse mortality (NRM), graft-versus-host disease (GVHD), relapse, and OS. RESULTS In all, 114 patients with a median age of 65 years received transplantations. The majority (52%) received transplantations from unrelated donors and were given antithymocyte globulin for GVHD prophylaxis. Disease-free survival and OS at 2 years after transplantation were 42% (95% CI, 33% to 52%) and 48% (95% CI, 39% to 58%), respectively, for the entire group and 40% (95% CI, 29% to 55%) and 50% (95% CI, 38% to 64%) for the unrelated donor group. NRM at 2 years was 15% (95% CI, 8% to 21%). Grade 2 to 4 acute GVHD occurred in 9.6% (95% CI, 4% to 15%) of patients, and chronic GVHD occurred in 28% (95% CI, 19% to 36%) of patients. The cumulative incidence of relapse at 2 years was 44% (95% CI, 35% to 53%). CONCLUSION Reduced-intensity conditioning HSCT to maintain remission in selected older patients with AML is relatively well tolerated and appears to provide superior outcomes when compared with historical patients treated without HSCT. GVHD and NRM rates were lower than expected. Future transplantation studies in these patients should focus on further reducing the risk of relapse.
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Affiliation(s)
- Steven M Devine
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA.
| | - Kouros Owzar
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - William Blum
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Flora Mulkey
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Richard M Stone
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Jack W Hsu
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Richard E Champlin
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Yi-Bin Chen
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Ravi Vij
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - James Slack
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Robert J Soiffer
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Richard A Larson
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Thomas C Shea
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Vera Hars
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Alexander B Sibley
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Sergio Giralt
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Shelly Carter
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Mary M Horowitz
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Charles Linker
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
| | - Edwin P Alyea
- Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA
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Majhail NS, Farnia SH, Carpenter PA, Champlin RE, Crawford S, Marks DI, Omel JL, Orchard PJ, Palmer J, Saber W, Savani BN, Veys PA, Bredeson CN, Giralt SA, LeMaistre CF. Indications for Autologous and Allogeneic Hematopoietic Cell Transplantation: Guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2015; 21:1863-1869. [PMID: 26256941 DOI: 10.1016/j.bbmt.2015.07.032] [Citation(s) in RCA: 265] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 02/07/2023]
Abstract
Approximately 20,000 hematopoietic cell transplantation (HCT) procedures are performed in the United States annually. With advances in transplantation technology and supportive care practices, HCT has become safer, and patient survival continues to improve over time. Indications for HCT continue to evolve as research refines the role for HCT in established indications and identifies emerging indications where HCT may be beneficial. The American Society for Blood and Marrow Transplantation (ASBMT) established a multiple-stakeholder task force consisting of transplant experts, payer representatives, and a patient advocate to provide guidance on "routine" indications for HCT. This white paper presents the recommendations from the task force. Indications for HCT were categorized as follows: (1) Standard of care, where indication for HCT is well defined and supported by evidence; (2) Standard of care, clinical evidence available, where large clinical trials and observational studies are not available but HCT has been shown to be effective therapy; (3) Standard of care, rare indication, for rare diseases where HCT has demonstrated effectiveness but large clinical trials and observational studies are not feasible; (4) Developmental, for diseases where preclinical and/or early phase clinical studies show HCT to be a promising treatment option; and (5) Not generally recommended, where available evidence does not support the routine use of HCT. The ASBMT will periodically review these guidelines and will update them as new evidence becomes available.
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Affiliation(s)
| | | | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - David I Marks
- Adult BMT Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Paul J Orchard
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Jeanne Palmer
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | - Wael Saber
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Paul A Veys
- Bone Marrow Transplantation Unit, Great Ormond Street Hospital for Children, London, UK
| | | | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
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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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Abstract
Plasma cell myeloma (PCM) is a hematologic malignancy that primarily affects the elderly. Approximately two-thirds of patients are aged 65 years or older at diagnosis. Major advances in testing, treatment, and supportive care have resulted in substantial improvement in overall survival in younger, standard-risk, PCM patients over the past 3 decades. However, this positive impact progressively diminishes with advancing age, with some studies showing no improvement in survival outcomes in the elderly. Slow improvement in survival for elderly PCM patients is likely multifactorial, influenced by factors such as age-related physiologic changes, increased comorbidities, decreased treatment tolerance, socioeconomic barriers, and possible differences in disease biology. The standard approach of basing treatment decisions on age and performance status does not account for this complexity, and can be insufficient to determine the risks and benefits of treatment. Comprehensive geriatric assessment (CGA) produces a more thorough iteration of the factors influencing an individual's treatment risk, and can potentially identify targets for intervention to lower risk. Ongoing studies are looking at developing and refining the tools available for risk screening and assessment. Treating elderly PCM patients with novel agent-based regimens with or without autologous stem cell transplantation has improved response rates and survival in some studies, but elderly PCM patients have benefitted less than their younger counterparts from recent advances in PCM treatment. Personalizing treatment decisions, based on predictions of risk, determined by geriatric assessment, and response, determined by precision medicine (our understanding of the genetic, molecular, and cellular pathways that drive an individual's cancer) will help maximize the benefit and minimize the risk of PCM treatment for each patient. Continued evaluation of new strategies and treatments for PCM in clinical trials specifically designed for elderly patients is needed to continue to improve outcomes for elderly PCM patients in the future.
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Holmes HM, Des Bordes JKA, Kebriaei P, Yennu S, Champlin RE, Giralt S, Mohile SG. Optimal screening for geriatric assessment in older allogeneic hematopoietic cell transplantation candidates. J Geriatr Oncol 2014; 5:422-30. [PMID: 24835889 DOI: 10.1016/j.jgo.2014.04.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/05/2014] [Accepted: 04/28/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Older patients who receive hematopoietic cell transplantation (HCT) may be at risk for adverse outcomes due to age-related conditions or frailty. Geriatric assessment (GA) has been used to evaluate HCT candidates but can be time-consuming. We therefore sought to determine the predictive ability of two screening tools, the Vulnerable Elders Survey (VES-13) and the G8, for abnormal GA or frailty. MATERIALS AND METHODS We enrolled 50 allogeneic HCT candidates age ≥60 years. The GA included measures of medical, physical, functional, and social health. Frailty was defined as 3 or more abnormalities on grip strength, gait speed, weight loss, exhaustion, and activity. We associated baseline characteristics and abnormal GA or frailty. We determined the sensitivity and predictive ability of the VES-13 and G8 for GA and frailty. RESULTS Overall, 33 (66%) patients (mean age 65.4 years) had an abnormal GA, and 11 patients (22%) were frail. The G8 screening tool had a higher sensitivity for an abnormal GA (69.7%), and the VES-13 had a higher specificity (100%). Both tools had similar discriminatory ability. CONCLUSIONS Older HCT candidates had a significant number of deficits on baseline GA and a high prevalence of frailty. Existing screening tools may not be able to replace a full GA.
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Affiliation(s)
- Holly M Holmes
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jude K A Des Bordes
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sriram Yennu
- Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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