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Fraebel J, Park S, Shah R, Prieto-Granada C, Mason EF, Sengsayadeth S, Chinratanalab W, Savani B, Jayani RV, Kassim A, Dholaria BR, Kim TK. GVHD like skin eruption post-autologous stem cell transplantation. Bone Marrow Transplant 2024:10.1038/s41409-024-02259-6. [PMID: 38467749 DOI: 10.1038/s41409-024-02259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Johnathan Fraebel
- Division of Hematology/Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Silvia Park
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Rahul Shah
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Carlos Prieto-Granada
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Emily F Mason
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Salyka Sengsayadeth
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Wichai Chinratanalab
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Bipin Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Reena V Jayani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
| | - Adetola Kassim
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Bhagirathbhai R Dholaria
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Tae Kon Kim
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA.
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA.
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Marvin-Peek J, Mason EF, Kishtagari A, Jayani RV, Dholaria B, Kim TK, Engelhardt BG, Chen H, Strickland S, Savani B, Ferrell B, Kassim A, Savona M, Mohan S, Byrne M. TP53 mutations are associated with increased infections and reduced hematopoietic cell transplantation rates in myelodysplastic syndrome and acute myeloid leukemia. Transplant Cell Ther 2023:S2666-6367(23)01166-1. [PMID: 36906277 DOI: 10.1016/j.jtct.2023.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Although allogeneic hematopoietic cell transplantation (HCT) is the only potentially curative therapy for patients with poor-risk myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML), only a minority of these patients undergo HCT. TP53-mutated (TP53MUT) MDS/AML is particularly high risk, yet fewer TP53MUT patients undergo HCT than other poor-risk TP53-wild type (TP53WT) patients. OBJECTIVE We hypothesized that TP53MUT MDS/AML patients have unique risk factors affecting rates of HCT, and therefore investigated phenotypic changes that may prevent patients with TP53MUT MDS/AML from receiving HCT. STUDY DESIGN This study was a single center retrospective analysis of outcomes for adults with newly diagnosed MDS or AML (n=352). HLA typing was used as a surrogate for physician "intent to transplant." Multivariable logistic regression models were used to estimate odds ratios (OR) for factors associated with HLA typing, HCT, and pre-transplant infections. Multivariable Cox proportional hazards models were used to create predicted survival curves for patients with and without TP53 mutations. RESULTS Overall significantly fewer TP53MUT patients underwent HCT compared to TP53WT patients (19% versus 31%, p=0.028). Development of an infection was significantly associated with decreased odds of HCT (OR=0.42, 95% CI: 0.19-0.90) and worse overall survival (HR=1.46, 95% CI: 1.09-1.96) in multivariable analyses. TP53MUT disease was independently associated with increased odds of developing an infection (OR 2.18, 95% CI: 1.21-3.93), bacterial pneumonia (OR 1.83, 95% CI: 1.00-3.33), and invasive fungal infection (OR 2.64, 95% CI: 1.34-5.22) prior to HCT. Infections were the cause of death in significantly more patients with TP53MUT disease (38% vs 19%, p=0.005). CONCLUSIONS With substantially more infections and decreased HCT rates in patients with TP53 mutations, this raises the possibility that phenotypic changes occurring in TP53MUT disease may affect infection susceptibility in this population and drastically impact clinical outcomes.
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Affiliation(s)
| | - Emily F Mason
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville TN
| | - Ashwin Kishtagari
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN
| | - Reena V Jayani
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN
| | | | - Tae Kon Kim
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville TN
| | - Brian G Engelhardt
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville TN
| | - Stephen Strickland
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN
| | - Bipin Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN
| | - Brent Ferrell
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN
| | - Adetola Kassim
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN
| | - Michael Savona
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN
| | - Sanjay Mohan
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN
| | - Michael Byrne
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN; Tennessee Oncology Midtown Center for Blood Cancers, Nashville TN.
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Saad A, Loren A, Bolaños-Meade J, Chen G, Couriel D, Di Stasi A, El-Jawahri A, Elmariah H, Farag S, Gundabolu K, Gutman J, Ho V, Hoeg R, Horwitz M, Hsu J, Kassim A, Kharfan Dabaja M, Magenau J, Martin T, Mielcarek M, Moreira J, Nakamura R, Nieto Y, Ninos C, Oliai C, Patel S, Randolph B, Schroeder M, Tzachanis D, Varshavsky-Yanovsky AN, Vusirikala M, Algieri F, Pluchino LA. NCCN Guidelines® Insights: Hematopoietic Cell Transplantation, Version 3.2022. J Natl Compr Canc Netw 2023; 21:108-115. [PMID: 36791762 DOI: 10.6004/jnccn.2023.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The NCCN Guidelines for Hematopoietic Cell Transplantation (HCT) provide an evidence- and consensus-based approach for the use of autologous and allogeneic HCT in the management of malignant diseases in adult patients. HCT is a potentially curative treatment option for patients with certain types of malignancies; however, recurrent malignancy and transplant-related complications often limit the long-term survival of HCT recipients. The purpose of these guidelines is to provide guidance regarding aspects of HCT, including pretransplant recipient evaluation, hematopoietic cell mobilization, and treatment of graft-versus-host disease-a major complication of allogeneic HCT-to enable the patient and clinician to assess management options in the context of an individual patient's condition. These NCCN Guidelines Insights provide a summary of the important recent updates to the NCCN Guidelines for HCT, including the incorporation of a newly developed section on the Principles of Conditioning for HCT.
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Affiliation(s)
- Ayman Saad
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Alison Loren
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | | | - Sherif Farag
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | | | - Vincent Ho
- Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | | | | | - Thomas Martin
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Jonathan Moreira
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Yago Nieto
- The University of Texas MD Anderson Cancer Center
| | | | | | - Seema Patel
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Brion Randolph
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Mark Schroeder
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
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Murphy D, Wilkerson K, Logue M, Vaughn LA, Akhom P, Biltibo E, Gatwood KS, Orton L, Dholaria B, Savani B, Engelhardt BG, Sengsayadeth S, Kitko CL, Connelly J, Jayani RV, Kassim A. ABO Incompatibility Did Not Impact Outcomes after Haploidentical Bone Marrow Transplantation with Posttransplant Cyclophosphamide for Patients with Sickle Cell Disease: Single Center Experience. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Snider C, Budhwani H, Logue M, Goyal P, Pugh K, Murff H, Kassim A, Jayani R. HEALTHCARE UTILIZATION IN OLDER ADULTS (≥70 YEARS) UNDERGOING CELLULAR THERAPY FOR HEMATOLOGIC MALIGNANCIES. Innov Aging 2022. [PMCID: PMC9770591 DOI: 10.1093/geroni/igac059.2536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Increasingly, older adults are receiving hematopoietic cell transplant (HCT) and chimeric antigen receptor T-cell therapy (CAR-T), intensive therapies for treatment of hematologic cancers which typically require prolonged hospital admissions. Older adults are at high risk of increased healthcare utilization and complications of prolonged hospitalization [Mudge, J Am Geriatr Soc, 2019]. We identified patients age ≥70 years who received HCT or CAR-T in a primary outpatient transplant program at Vanderbilt University Medical Center between 1/1/19 and 12/31/20. Healthcare utilization, including all visits and admissions, was captured from the start of conditioning chemotherapy through early post-therapy. Thirty-eight patients met inclusion criteria; 26 (68%) received autologous HCT (autoHCT), 7 (18%) allogenic HCT (alloHCT), and 5 (13%) CAR-T. Twenty-four patients (63%) had high HCT-Comorbidity Index (HCT-CI). Eighteen (69%) autoHCT, 6 (86%) alloHCT, and no CAR-T patients had at least one unplanned admission. The median number of total hospital days (LOS) was 7.5 (2-14), 8 (4-62), and 9 (7-9) days, respectively. One-year mortality was 12% (3) in autoHCT, 43% (3) in alloHCT, and 0% in CAR-T. Low performance status and high HCT-CI did not correlate with LOS (p=0.58 and p=0.16, respectively) or number of outpatient visits (p=1, p=0.19). In conclusion, most patients who received auto- or alloHCT in a planned primary outpatient setting experienced at least one unplanned admission. LOS duration varied widely with shorter LOS among autoHCT patients. Further research is needed to identify factors among older adults (≥70 years) at risk of increased healthcare utilization during HCT or CAR-T.
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Affiliation(s)
- Christina Snider
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Hina Budhwani
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Melissa Logue
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Parul Goyal
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Kelly Pugh
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Harvey Murff
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Adetola Kassim
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Reena Jayani
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Milton R, Modibbo F, Gillespie D, Alkali FI, Mukaddas AS, Kassim A, Sa'ad FH, Tukur FM, Khalid RY, Muhammad MY, Bello M, Edwin CP, Ogudo E, Iregbu KC, Jones L, Hood K, Ghazal P, Sanders J, Hassan B, Belga FJ, Walsh TR. Incidence and sociodemographic, living environment and maternal health associations with stillbirth in a tertiary healthcare setting in Kano, Northern Nigeria. BMC Pregnancy Childbirth 2022; 22:692. [PMID: 36076161 PMCID: PMC9454147 DOI: 10.1186/s12884-022-04971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Almost two million stillbirths occur annually, most occurring in low- and middle-income countries. Nigeria is reported to have one of the highest stillbirth rates on the African continent. The aim was to identify sociodemographic, living environment, and health status factors associated with stillbirth and determine the associations between pregnancy and birth factors and stillbirth in the Murtala Mohammed Specialist Hospital, Kano, Nigeria. Methods A three-month single-site prospective observational feasibility study. Demographic and clinical data were collected. We fitted bivariable and multivariable models for stillbirth (yes/no) and three-category livebirth/macerated stillbirth/non-macerated stillbirth outcomes to explore their association with demographic and clinical factors. Findings 1,998 neonates and 1,926 mothers were enrolled. Higher odds of stillbirth were associated with low-levels of maternal education, a further distance to travel to the hospital, living in a shack, maternal hypertension, previous stillbirth, birthing complications, increased duration of labour, antepartum haemorrhage, prolonged or obstructed labour, vaginal breech delivery, emergency caesarean-section, and signs of trauma to the neonate following birth. Interpretation This work has obtained data on some factors influencing stillbirth. This in turn will facilitate the development of improved public health interventions to reduce preventable deaths and to progress maternal health within this site. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04971-x.
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Affiliation(s)
- Rebecca Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F Modibbo
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - D Gillespie
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - F I Alkali
- Department of Biochemistry, Bayero University, Kano, Nigeria
| | - A S Mukaddas
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - A Kassim
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - F H Sa'ad
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - F M Tukur
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - R Y Khalid
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - M Y Muhammad
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - M Bello
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - C P Edwin
- Department of Microbiology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - E Ogudo
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - K C Iregbu
- Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria
| | - L Jones
- Department of Medical Microbiology Cardiff, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - P Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - B Hassan
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F J Belga
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - T R Walsh
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.,Department of Zoology, Ineos Institute of Antimicrobial Research, University of Oxford, Oxford, UK
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Patel V, Dholaria B, Jayani R, Sengsayadeth S, Wigger M, Horst S, Lindenfeld J, Schlendorf K, Ooi H, Brinkley M, Zalawadiya S, Pedrotty D, Hoffman J, Hung R, Goodman S, Savani B, Kassim A, Harrell S, Punnoose L. Long Term Hematologic and Graft Outcomes After Cardiac Transplant in Al Amyloidosis. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mirza AS, Byrne M, Huntington S, Shallis RM, Zeidan A, Foss FM, Isufi I, Podoltsev N, Engelhardt BG, Kassim A, Savani B, Dholaria B, Jayani RV, Perrault S, Schiffer M, Seropian SE, Gowda L. Impact of Post-Remission Consolidation Therapy on Outcomes of Haploidentical Hematopoietic Cell Transplantation for Acute Myelogenous Leukemia. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Marvin-Peek J, Mason E, Jayani RV, Dholaria B, Kim TK, Engelhardt BG, Chen H, Kassim A, Savona MR, Savani B, Strickland SA, Mohan S, Byrne M. Factors Affecting Low Hematopoietic Cell Transplantation Rates in TP53-Mutated MDS/AML and Predictors of Overall Survival. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abdullahi SU, Jibir BW, Bello-Manga H, Gambo S, Inuwa H, Tijjani AG, Idris N, Galadanci A, Hikima MS, Galadanci N, Borodo A, Tabari AM, Haliru L, Suleiman A, Ibrahim J, Greene BC, Ghafuri DL, Rodeghier M, Slaughter JC, Kirkham FJ, Neville K, Kassim A, Trevathan E, Jordan LC, Aliyu MH, DeBaun MR. Hydroxyurea for primary stroke prevention in children with sickle cell anaemia in Nigeria (SPRING): a double-blind, multicentre, randomised, phase 3 trial. Lancet Haematol 2022; 9:e26-e37. [PMID: 34971579 PMCID: PMC10072240 DOI: 10.1016/s2352-3026(21)00368-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In high-income countries, standard care for primary stroke prevention in children with sickle cell anaemia and abnormal transcranial Doppler velocities results in a 92% relative risk reduction of strokes but mandates initial monthly blood transfusion. In Africa, where regular blood transfusion is not feasible for most children, we tested the hypothesis that initial moderate-dose compared with low-dose hydroxyurea decreases the incidence of strokes for children with abnormal transcranial Doppler velocities. METHODS SPRING is a double-blind, parallel-group, randomised, controlled, phase 3 trial of children aged 5-12 years with sickle cell anaemia with abnormal transcranial Doppler velocities conducted at three teaching hospitals in Nigeria. For randomisation, we used a permuted block allocation scheme with block sizes of four, stratified by sex and site. Allocation was concealed from all but the pharmacists and statisticians. Participants were assigned in a 1:1 ratio to low-dose (10 mg/kg per day) or moderate-dose (20 mg/kg per day) oral hydroxyurea taken once daily with monthly clinical evaluation and laboratory monitoring. The primary outcome was initial stroke or transient ischaemic attack, centrally adjudicated. The secondary outcome was all-cause hospitalisation. We used the intention-to-treat population for data analysis. The trial was stopped early for futility after a planned minimum follow-up of 3·0 years to follow-up for participants. This trial was registered with ClinicalTrials.gov, number NCT02560935. FINDINGS Between Aug 2, 2016, and June 14, 2018, 220 participants (median age 7·2 years [IQR 5·5-8·9]; 114 [52%] female) were randomly allocated and followed for a median of 2·4 years (IQR 2·0-2·8). All participants were Nigerian and were from the following ethnic groups: 179 (82%) people were Hausa, 25 (11%) were Fulani, and 16 (7%) identified as another ethnicity. In the low-dose hydroxyurea group, three (3%) of 109 participants had strokes, with an incidence rate of 1·19 per 100 person-years and in the moderate-dose hydroxyurea group five (5%) of 111 had strokes with an incidence rate of 1·92 per 100 person-years (incidence rate ratio 0·62 [95% CI 0·10-3·20], p=0·77). The incidence rate ratio of hospitalisation for any reason was 1·71 (95% CI 1·15-2·57, p=0·0071), with higher incidence rates per 100 person-years in the low-dose group versus the moderate-dose group (27·43 vs 16·08). No participant had hydroxyurea treatment stopped for myelosuppression. INTERPRETATION Compared with low-dose hydroxyurea therapy, participants treated with moderate-dose hydroxyurea had no difference in the stroke incidence rate. However, secondary analyses suggest that the moderate-dose group could lower incidence rates for all-cause hospitalisations. These findings provide an evidence-based guideline for the use of low-dose hydroxyurea therapy for children with sickle cell anaemia at risk of stroke. FUNDING National Institute of Neurological Disorders and Stroke.
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Affiliation(s)
- Shehu U Abdullahi
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Binta W Jibir
- Department of Pediatrics, Hasiya Bayero Pediatric Hospital, Kano, Nigeria
| | - Halima Bello-Manga
- Department of Haematology and Blood Transfusion, Kaduna State University/Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Safiya Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Hauwa Inuwa
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aliyu G Tijjani
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Nura Idris
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Aisha Galadanci
- Department of Haematology and Blood Transfusion, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mustapha S Hikima
- Department of Radiology, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - Najibah Galadanci
- Department of Epidemiology, School of Public health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Awwal Borodo
- Department of Medicine, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Abdulkadir M Tabari
- Department of Radiology, Kaduna State University, Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Lawal Haliru
- Department of Pediatrics, Kaduna State University, Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Aisha Suleiman
- Department of Pediatrics, Kaduna State University, Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Jamila Ibrahim
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Brittany C Greene
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Djamila L Ghafuri
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - James C Slaughter
- Department of Biostatistics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fenella J Kirkham
- Developmental Neurosciences, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Kathleen Neville
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Adetola Kassim
- Department of Hematology and Oncology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edwin Trevathan
- Vanderbilt Institute for Global Health, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Neurology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori C Jordan
- Department of Pediatrics, Neurology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael R DeBaun
- Vanderbilt Institute for Global Health, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA.
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Milton R, Alkali FI, Modibbo F, Sanders J, Mukaddas AS, Kassim A, Sa'ad FH, Tukur FM, Pell B, Hood K, Ghazal P, Iregbu KC. A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths. BMC Pregnancy Childbirth 2021; 21:830. [PMID: 34906118 PMCID: PMC8670111 DOI: 10.1186/s12884-021-04207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the experiences and perceptions of stillbirth among mothers from a tertiary medical centre in Kano, Northern Nigeria. Design Qualitative, interpretative. Setting Tertiary healthcare facility, Murtala Muhammad Specialist Hospital (MMSH), Kano, Northern Nigeria. Sample Mothers who had given birth to a liveborn baby at the MMSH in the prior 6 months (n = 31). In order to capture the experiences and perception of stillbirth within this cohort we approached mothers who had in a previous pregnancy experienced a stillbirth. Of the 31 who attended 16 had a previous stillbirth. Methods Semi-structured Focus Group Discussions, consisting of open-ended questions about stillbirth, beliefs, experiences and influences were held in MMSH, conducted over 1 day. Results Our findings highlight that this is a resource-poor tertiary facility serving an ever-growing population, increasing strain on the hospital and healthcare workers. Many of the participants highlighted needing permission from certain family members before accessing healthcare or medical treatment. We identified that mothers generally have knowledge on self-care during pregnancy, yet certain societal factors prevented that from being their priority. Judgement and blame was a common theme, yet a complex area entwined with traditions, superstitions and the pressure to procreate with many mothers described being made to feel useless and worthless if they did not birth a live baby. Conclusions As access to healthcare becomes easier, there are certain traditions, family and social dynamics and beliefs which conflict with scientific knowledge and act as a major barrier to uptake of healthcare services. The findings highlight the need for investment in maternity care, appropriate health education and public enlightenment; they will help inform appropriate interventions aimed at reducing stigma around stillbirth and aide in educating mothers about the importance of appropriate health seeking behaviour. Stillbirths are occurring in this area of the world unnecessarily, globally there has been extensive research conducted on stillbirth prevention. This research has highlighted some of the areas which can be tackled by modifying existing successful interventions to work towards reducing preventable stillbirths. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04207-4.
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Affiliation(s)
- R Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F I Alkali
- Department of Biochemistry, Bayero University, Kano, Nigeria
| | - F Modibbo
- Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - A S Mukaddas
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - A Kassim
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - F H Sa'ad
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - F M Tukur
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - B Pell
- Centre for the Development and Evaluation of Complex Intervention for Public Health Improvement, Cardiff University, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - P Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - K C Iregbu
- Department of Medical Microbiology, National Hospital, Abuja, Nigeria
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12
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Kharfan-Dabaja MA, Kumar A, Ayala E, Aljurf M, Nishihori T, Marsh R, Burroughs LM, Majhail N, Al-Homsi AS, Al-Kadhimi ZS, Bar M, Bertaina A, Boelens JJ, Champlin R, Chaudhury S, DeFilipp Z, Dholaria B, El-Jawahri A, Fanning S, Fraint E, Gergis U, Giralt S, Hamilton BK, Hashmi SK, Horn B, Inamoto Y, Jacobsohn DA, Jain T, Johnston L, Kanate AS, Kansagra A, Kassim A, Kean LS, Kitko CL, Knight-Perry J, Kurtzberg J, Liu H, MacMillan ML, Mahmoudjafari Z, Mielcarek M, Mohty M, Nagler A, Nemecek E, Olson TS, Oran B, Perales MA, Prockop SE, Pulsipher MA, Pusic I, Riches ML, Rodriguez C, Romee R, Rondon G, Saad A, Shah N, Shaw PJ, Shenoy S, Sierra J, Talano J, Verneris MR, Veys P, Wagner JE, Savani BN, Hamadani M, Carpenter PA. Standardizing Definitions of Hematopoietic Recovery, Graft Rejection, Graft Failure, Poor Graft Function, and Donor Chimerism in Allogeneic Hematopoietic Cell Transplantation: A Report on Behalf of the American Society for Transplantation and Cellular Therapy. Transplant Cell Ther 2021; 27:642-649. [PMID: 34304802 DOI: 10.1016/j.jtct.2021.04.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 11/21/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is potentially curative for certain hematologic malignancies and nonmalignant diseases. The field of allo-HCT has witnessed significant advances, including broadening indications for transplantation, availability of alternative donor sources, less toxic preparative regimens, new cell manipulation techniques, and novel GVHD prevention methods, all of which have expanded the applicability of the procedure. These advances have led to clinical practice conundrums when applying traditional definitions of hematopoietic recovery, graft rejection, graft failure, poor graft function, and donor chimerism, because these may vary based on donor type, cell source, cell dose, primary disease, graft-versus-host disease (GVHD) prophylaxis, and conditioning intensity, among other variables. To address these contemporary challenges, we surveyed a panel of allo-HCT experts in an attempt to standardize these definitions. We analyzed survey responses from adult and pediatric transplantation physicians separately. Consensus was achieved for definitions of neutrophil and platelet recovery, graft rejection, graft failure, poor graft function, and donor chimerism, but not for delayed engraftment. Here we highlight the complexities associated with the management of mixed donor chimerism in malignant and nonmalignant hematologic diseases, which remains an area for future research. We recognize that there are multiple other specific, and at times complex, clinical scenarios for which clinical management must be individualized.
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Affiliation(s)
- Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, Florida.
| | - Ambuj Kumar
- Program for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Ernesto Ayala
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, Florida
| | - Mahmoud Aljurf
- Department of Adult Hematology and Stem Cell Transplantation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Rebecca Marsh
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Navneet Majhail
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Zaid S Al-Kadhimi
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Merav Bar
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Alice Bertaina
- Division of Stem Cell Transplant and Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Jaap J Boelens
- Stem Cell Transplantation and Cellular Therapies Program, Department Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sonali Chaudhury
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Zachariah DeFilipp
- Department of Hematology-Oncology and Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Bhagirathbhai Dholaria
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Areej El-Jawahri
- Department of Hematology-Oncology and Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Suzanne Fanning
- Blood and Marrow Transplant Program, University of South Carolina School of Medicine, Greenville, South Carolina
| | - Ellen Fraint
- Stem Cell Transplantation and Cellular Therapies Program, Department Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Usama Gergis
- Bone Marrow Transplant and Immune Cellular Therapy, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Sergio Giralt
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center Weill Cornell Medical College, New York, New York
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Biljana Horn
- Department of Pediatrics, Division of Hematology/Oncology, University of Florida, UF Health Shands Children's Hospital, Gainesville, Florida
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - David A Jacobsohn
- Division of Blood and Marrow Transplantation Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC
| | - Tania Jain
- Hematologic Malignancies and Bone Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura Johnston
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | | | - Adetola Kassim
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leslie S Kean
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Carrie L Kitko
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jessica Knight-Perry
- Department of Pediatrics, Division of Hematology/Oncology/BMT, University of Colorado School of Medicine, Aurora, Colorado
| | - Joanne Kurtzberg
- Pediatric Blood and Marrow Transplant Program, Duke University School of Medicine, Durham, North Carolina
| | - Hien Liu
- Department of Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Margaret L MacMillan
- Blood and Marrow Transplant Program, Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, Minneapolis
| | - Zahra Mahmoudjafari
- Division of Pharmacy, University of Kansas Cancer Center, University of Kansas Health System, Lawrence, Kansas
| | | | - Mohamad Mohty
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine and Hôpital Saint-Antoine, Service d'Hématologie Clinique et Thérapie Cellulaire, Paris, France
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eneida Nemecek
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Timothy S Olson
- Blood and Marrow Transplant Section, Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Miguel-Angel Perales
- Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center Weill Cornell Medical College, New York, New York
| | - Susan E Prockop
- Stem Cell Transplantation and Cellular Therapies Program, Department Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Pulsipher
- Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, California
| | - Iskra Pusic
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Marcie L Riches
- Division of Hematology, University of North Carolina at Chapel Hill, North Carolina
| | - Cesar Rodriguez
- Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Rizwan Romee
- Cellular Therapy and Stem Cell Transplant Program, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ayman Saad
- Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Nina Shah
- Division of Hematology-Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Peter J Shaw
- The Children's Hospital at Westmead, Sydney, Australia
| | - Shalini Shenoy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jorge Sierra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Julie Talano
- Department of Pediatric Hematology/Oncology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael R Verneris
- Department of Pediatrics, Division of Hematology/Oncology/BMT, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul Veys
- Blood & Marrow Transplant Unit, Great Ormond Street Hospital, University College London, London, United Kingdom
| | - John E Wagner
- Blood and Marrow Transplant Program, Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, Minneapolis
| | - Bipin N Savani
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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13
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Iqbal M, Reljic T, Corbacioglu S, de la Fuente J, Gluckman E, Kumar A, Yassine F, Ayala E, El-Jawahri A, Murthy H, Almohareb F, Hashmi SK, Cappelli B, Alahmari A, Scigliuolo GM, Kassim A, Aljurf M, Kharfan-Dabaja MA. Systematic Review/Meta-Analysis on Efficacy of Allogeneic Hematopoietic Cell Transplantation in Sickle Cell Disease: An International Effort on Behalf of the Pediatric Diseases Working Party of European Society for Blood and Marrow Transplantation and the Sickle Cell Transplantation International Consortium. Transplant Cell Ther 2020; 27:167.e1-167.e12. [PMID: 33830027 DOI: 10.1016/j.jtct.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/28/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
Sickle cell disease (SCD) affects more than 300,000 children annually worldwide. Despite improved supportive care, long-term prognosis remains poor. Allogeneic hematopoietic cell transplantation (allo-HCT) is the sole validated curative option, resulting in sustained resolution of the clinical phenotype. The medical literature on allo-HCT for SCD is largely limited to children. Recent studies have evaluated allo-HCT efficacy in adults. Here, we conducted a systematic review/meta-analysis to assess the totality of evidence on the efficacy, or lack thereof, of allo-HCT in treating SCD. We performed a comprehensive literature search using PubMed/Medline, Embase, and Cochrane library databases on November 13, 2019. Four authors independently extracted data on clinical outcomes related to benefits (overall survival [OS] and disease-free survival [DFS]) and harms (acute graft-versus-host disease [aGVHD], chronic graft-versus-host disease [cGVHD], nonrelapse mortality [NRM], and graft failure [GF]). Our search identified a total of 1906 references. Only 33 studies (n= 2853 patients) met our inclusion criteria. We also performed a subset analysis by age. Analyses of all-age groups showed pooled rates of 96% for OS, 90% for DFS, 20% for aGVHD, 10% for cGVHD, 4% for NRM, and 5% for GF. In the pediatric population, pooled rates for OS, DFS, aGVHD, cGVHD, NRM, and GF were 97%, 91%, 26%, 11%, 5%, and 3%, respectively. In adults, pooled rates for OS, DFS, aGVHD, cGVHD, NRM, and GF were 98%, 90%, 7%, 1%, 0%, and 14%, respectively. Our data show that allo-HCT is safe and effective, yielding pooled OS rates exceeding 90%. The high GF rate of 14% in adults is concerning and emphasizes the need to evaluate new strategies.
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Affiliation(s)
- Madiha Iqbal
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, Florida
| | - Tea Reljic
- Program for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Germany
| | - Josu de la Fuente
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Eliane Gluckman
- Eurocord, Paris-Diderot University Equipe d'Accueil 3518, Hospital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Ambuj Kumar
- Program for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Farah Yassine
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, Florida
| | - Ernesto Ayala
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, Florida
| | - Areej El-Jawahri
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hemant Murthy
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, Florida
| | - Fahad Almohareb
- Adult Hematology/Bone Marrow Transplantation, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shahrukh K Hashmi
- Adult Hematology/Bone Marrow Transplantation, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Barbara Cappelli
- Eurocord, Paris-Diderot University Equipe d'Accueil 3518, Hospital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Ali Alahmari
- Adult Hematology/Bone Marrow Transplantation, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Graziana Maria Scigliuolo
- Eurocord, Paris-Diderot University Equipe d'Accueil 3518, Hospital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Adetola Kassim
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Mahmoud Aljurf
- Adult Hematology/Bone Marrow Transplantation, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, Florida.
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14
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Byrne M, Danielson N, Sengsayadeth S, Rasche A, Culos K, Gatwood K, Wyatt H, Chinratanalab W, Dholaria B, Ferrell PB, Fogo K, Goodman S, Jagasia M, Jayani R, Kassim A, Mohan SR, Savani BN, Strickland SA, Engelhardt BG, Savona M. The use of venetoclax-based salvage therapy for post-hematopoietic cell transplantation relapse of acute myeloid leukemia. Am J Hematol 2020; 95:1006-1014. [PMID: 32390196 DOI: 10.1002/ajh.25859] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/26/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
For patients with high risk myeloid disease, allogeneic hematopoietic cell transplantation (HCT) is the only potentially curative therapy. Unfortunately, many of these patients relapse after HCT and have a limited survival. The recent approval of venetoclax, an orally bioavailable BCL-2 inhibitor, resulted in significant responses in treatment naïve acute myeloid leukemia (AML), and off-label use in the relapsed/refractory setting is increasing. We report the outcomes of 21 patients who underwent allogeneic HCT for myeloid disease, relapsed with AML, and were treated with venetoclax. Several patients had poor risk features including antecedent hematologic malignancy (6/21), complex karyotype (6/21), and TP53 mutations (5/21). The median age was 64.5 years and time from HCT to relapse was 5.7 months (range: 0.9 to 44.9 months). Of the 19 patients who were assessed for response, there were meaningful treatment responses seen in eight patients: five CR, three CRi, zero PR, for an ORR of 42.1%. Treatment effect was seen in six additional patients, including four in the morphologic leukemia-free state. Nine patients maintained their response for ≥3 months and eight were receiving therapy at data cut. Post-HCT AML relapse has an exceedingly poor outcome, and venetoclax-based therapy is a potent therapy option that should be studied prospectively in this setting.
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Affiliation(s)
- Michael Byrne
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
| | | | - Salyka Sengsayadeth
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Tennessee Valley Healthcare System Nashville Tennessee USA
| | - Adrianne Rasche
- Department of Nursing Vanderbilt University Medical Center Nashville Tennessee USA
| | - Katie Culos
- Department of Pharmacy Vanderbilt University Medical Center Nashville Tennessee USA
| | - Katie Gatwood
- Department of Pharmacy Vanderbilt University Medical Center Nashville Tennessee USA
| | - Houston Wyatt
- Department of Pharmacy Vanderbilt University Medical Center Nashville Tennessee USA
| | - Wichai Chinratanalab
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Tennessee Valley Healthcare System Nashville Tennessee USA
| | - Bhagirathbhai Dholaria
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
| | - P. Brent Ferrell
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
| | - Kristin Fogo
- Department of Nursing Vanderbilt University Medical Center Nashville Tennessee USA
| | - Stacey Goodman
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Tennessee Valley Healthcare System Nashville Tennessee USA
| | - Madan Jagasia
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
| | - Reena Jayani
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
| | - Adetola Kassim
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
| | - Sanjay R. Mohan
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
| | - Bipin N. Savani
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
| | - Stephen A. Strickland
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
| | - Brian G. Engelhardt
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
| | - Michael Savona
- Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee USA
- Program in Cancer Biology Vanderbilt University Nashville Tennessee USA
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15
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Abstract
Blood transfusions are an integral component of the management of acute and chronic complications of sickle cell disease. Red cells can be administered as a simple transfusion, part of a modified exchange procedure involving manual removal of autologous red cells and infusion of donor red cells, and part of an automated red cell exchange procedure using apheresis techniques. Individuals with sickle cell disease are at risk of multiple complications of blood transfusions, including transfusional hemosiderosis, auto- and alloimmunization to minor red cell and human leukocyte antigens, delayed hemolytic transfusion reactions, and hyper-hemolysis. In low- and middle-income countries in sub-Saharan Africa, where a directed donor system is prevalent and limited laboratory methods are in place to perform extended red cell phenotyping, leukodepletion of cellular products, and infectious disease screening, there are additional challenges to providing safe and adequate transfusion support for this patient population. We review current indications for acute and chronic transfusions in sickle cell disease that are derived primarily from randomized controlled trials and observational studies in children living in high-income countries. We will highlight populations with unique transfusion needs, such as pregnant women and children, as well as the role of the transfusion medicine consultative service for individuals with sickle cell disease planning to have curative hematopoietic stem cell transplantation or gene therapy. Finally, we will discuss risk factors for alloimmunization in individuals with sickle cell disease, emerging new strategies to prevent alloimmunization in this population, and critical gaps in the implementation of transfusion guidelines for sickle cell disease in high- and low-income countries.
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Affiliation(s)
- Deva Sharma
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Transfusion Medicine, Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ann Abiola Ogbenna
- Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adetola Kassim
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt-Meharry Sickle Cell Center of Excellence, Vanderilt University Medical Center, Nashville, TN, USA.
| | - Jennifer Andrews
- Division of Transfusion Medicine, Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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16
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Cronin RM, Yang M, Hankins JS, Byrd J, Pernell BM, Kassim A, Adams-Graves P, Thompson AA, Kalinyak K, DeBaun M, Treadwell M. Association between hospital admissions and healthcare provider communication for individuals with sickle cell disease. ACTA ACUST UNITED AC 2020; 25:229-240. [PMID: 32552526 DOI: 10.1080/16078454.2020.1780737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To test the hypothesis that caregivers' or adult participants' low ratings of provider communication are associated with more hospital admissions among adults and children with sickle cell disease (SCD), respectively. Secondarily, we determined whether there was an association between the caregivers' or participants' health literacy and rating of providers' communication. Methods: Primary data were collected from participants through surveys between 2014 and 2016, across six sickle cell centers throughout the U.S. In this cross-sectional cohort study, 211 adults with SCD and 331 caregivers of children with SCD completed surveys evaluating provider communication using the Consumer Assessment of Healthcare Providers and Systems (CAHPS), healthcare utilization, health literacy, and other sociodemographic and behavioral variables. Analyses included descriptive statistics, bivariate analyses, and logistic regression. Results: Participants with better ratings of provider communication were less likely to be hospitalized (odds ratio (OR) = 0.54, 95% confidence interval (CI) = [0.35, 0.83]). Positive ratings of provider communication were associated with fewer readmissions for children (OR = 0.23, 95% CI = [0.09, 0.57]). Participants with better ratings of provider communication were less likely to rate their health literacy as lower (regression coefficient (B) = -0.28, 95% CI = [-0.46, -0.10]). Conclusions: Low ratings of provider communication were associated with more hospitalizations and readmissions in SCD, suggesting the need for interventions targeted at improving patient-provider communication which could decrease hospitalizations for this population.
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Affiliation(s)
- Robert M Cronin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, RI, USA.,American Institutes for Research, Chapel Hill, NC, USA
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeannie Byrd
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brandi M Pernell
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Division of Hematology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adetola Kassim
- Department of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Patricia Adams-Graves
- Department of General Internal Medicine and Hematology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alexis A Thompson
- Department of Pediatrics, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen Kalinyak
- Division of Hematology in Cancer and Blood Diseases Institute, University of Cincinnati, Cincinnati, OH, USA
| | - Michael DeBaun
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marsha Treadwell
- Department of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
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Corbacioglu S, Gluckman E, Alahmari A, Kassim A, de la Fuente J. Proceedings of the meeting of the Pediatric Disease Working Party (PDWP) of the European group for Blood and Marrow Transplantation (EBMT) on sickle cell disease 16-17 May 2019, Regensburg, Germany. Hematol Oncol Stem Cell Ther 2020; 13:51-52. [PMID: 32202247 DOI: 10.1016/j.hemonc.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 12/28/2019] [Indexed: 10/24/2022] Open
Affiliation(s)
- Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Germany.
| | - Eliane Gluckman
- Eurocord, Paris-Diderot University Equipe d'Accueil 3518, Hospital Saint Louis, Paris, France
| | - Ali Alahmari
- Adult Hematology/HSCT, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Adetola Kassim
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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Field JJ, Kassim A, Brandow A, Embury SH, Matsui N, Wilkerson K, Bryant V, Zhang L, Simpson P, DeBaun MR. Phase 2 trial of montelukast for prevention of pain in sickle cell disease. Blood Adv 2020; 4:1159-1165. [PMID: 32208487 PMCID: PMC7094028 DOI: 10.1182/bloodadvances.2019001165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/28/2020] [Indexed: 12/23/2022] Open
Abstract
Cysteinyl leukotrienes (CysLTs) are lipid mediators of inflammation. In patients with sickle cell disease (SCD), levels of CysLTs are increased compared with controls and associated with a higher rate of hospitalization for pain. We tested the hypothesis that administration of the CysLT receptor antagonist montelukast would improve SCD-related comorbidities, including pain, in adolescents and adults with SCD. In a phase 2 randomized trial, we administered montelukast or placebo for 8 weeks. The primary outcome measure was a >30% reduction in soluble vascular cell adhesion molecule 1 (sVCAM), a marker of vascular injury. Secondary outcome measures were reduction in daily pain, improvement in pulmonary function, and improvement in microvascular blood flow, as measured by laser Doppler velocimetry. Forty-two participants with SCD were randomized to receive montelukast or placebo for 8 weeks. We found no difference between the montelukast and placebo groups with regard to the levels of sVCAM, reported pain, pulmonary function, or microvascular blood flow. Although montelukast is an effective treatment for asthma, we did not find benefit for SCD-related outcomes. This clinical trial was registered at www.clinicaltrials.gov as #NCT01960413.
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Affiliation(s)
- Joshua J Field
- Medical Sciences Institute, Versiti Wisconsin, Milwaukee, WI
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Adetola Kassim
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Amanda Brandow
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Neil Matsui
- Vanguard Therapeutics, Inc., Half Moon Bay, CA; and
| | - Karina Wilkerson
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Valencia Bryant
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Michael R DeBaun
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
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Patel DA, Dhedin N, Chen H, Karnik L, Gatwood K, Culos K, Mohan S, Engelhardt BG, Kitko C, Connelly J, Satyanarayana G, Jagasia M, De La Fuente J, Kassim A. Early viral reactivation despite excellent immune reconstitution following haploidentical Bone marrow transplant with post‐transplant cytoxan for sickle cell disease. Transpl Infect Dis 2019; 22:e13222. [DOI: 10.1111/tid.13222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/11/2019] [Accepted: 11/24/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Dilan A. Patel
- Department of Hematology and Bone Marrow Transplant Vanderbilt University Medical Center Nashville TN USA
| | - Nathalie Dhedin
- Department of Haematology for Adolescents and Young Adults Saint‐Louis Hospital Paris France
| | - Heidi Chen
- Department of Biostatistics Vanderbilt University School of Medicine Nashville TN USA
| | - Leena Karnik
- Department of Paediatrics St. Mary’s Hospital Imperial College London UK
| | - Katie Gatwood
- Department of Pharmaceutical Services Vanderbilt University Medical Center Nashville TN USA
| | - Katie Culos
- Department of Pharmaceutical Services Vanderbilt University Medical Center Nashville TN USA
| | - Sanjay Mohan
- Department of Hematology and Bone Marrow Transplant Vanderbilt University Medical Center Nashville TN USA
| | - Brian G. Engelhardt
- Department of Hematology and Bone Marrow Transplant Vanderbilt University Medical Center Nashville TN USA
| | - Carrie Kitko
- Department of Pediatrics Pediatric Hematology and Bone Marrow Transplant Vanderbilt Childrens Hospital Nashville TN USA
| | - Jim Connelly
- Department of Pediatrics Pediatric Hematology and Bone Marrow Transplant Vanderbilt Childrens Hospital Nashville TN USA
| | - Gowri Satyanarayana
- Department of Infectious Disease Vanderbilt University Medical Center Nashville TN USA
| | - Madan Jagasia
- Department of Hematology and Bone Marrow Transplant Vanderbilt University Medical Center Nashville TN USA
| | - Josu De La Fuente
- Department of Paediatrics St. Mary’s Hospital Imperial College London UK
| | - Adetola Kassim
- Department of Hematology and Bone Marrow Transplant Vanderbilt University Medical Center Nashville TN USA
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20
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Sheth V, Kennedy V, de Lavallade H, Mclornan D, Potter V, Engelhardt BG, Savani B, Chinratanalab W, Goodman S, Greer J, Kassim A, York S, Kenyon M, Gandhi S, Kulasekararaj A, Marsh J, Mufti G, Pagliuca A, Jagasia M, Raj K. Differential Interaction of Peripheral Blood Lymphocyte Counts (ALC) With Different in vivo Depletion Strategies in Predicting Outcomes of Allogeneic Transplant: An International 2 Center Experience. Front Oncol 2019; 9:623. [PMID: 31355140 PMCID: PMC6636242 DOI: 10.3389/fonc.2019.00623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/24/2019] [Indexed: 11/17/2022] Open
Abstract
Dosing regimens for antithymocyte globulin (ATG) and anti-CD52 antibody (alemtuzumab) for graft vs. host disease prophylaxis (GVHD) are empiric or weight-based, and do not account for individual patient factors. Recently, it has been shown that recipient peripheral blood absolute lymphocyte count (ALC) on the day of ATG administration interacts with the dose of ATG administered to predict transplantation outcome. Similarly, we wanted to analyze if the recipient ALC interacts with alemtuzumab dosing to predict outcomes. We retrospectively compared 364 patients, 124 patients receiving ATG (anti-thymocyte globulin) for GVHD prophylaxis, and undergoing unrelated first allogeneic transplant for myeloid and lymphoid malignancies (group 1) to 240 patients receiving alemtuzumab (group 2), in similar time period. There was no difference in survival or acute and chronic GVHD between 60 and 100 mg of alemtuzumab dosing. Unlike ATG (where the pre-transplant recipient ALC interacted with ATG dose on day of its administration (day 1) to predict OS and DFS (p = 0.05), within alemtuzumab group, the recipient ALC on second day of alemtuzumab administration (day 2) and its interaction with alemtuzumab dose strongly predicted OS, DFS and relapse (p = 0.05, HR-1.81, 1.1–3.3; p = 0.002, HR-2.41, CI, 1.3–4.2; and p = 0.003, HR-2.78, CI, 1.4–5.2), respectively. ALC (day 2) of 0.08 × 109/lit or higher, had a specificity of 96% in predicting inferior DFS. Like ATG, there is definite but differential interaction between the recipient peripheral blood ALC and alemtuzumab dose to predict OS, DFS, and relapses.
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Affiliation(s)
- Vipul Sheth
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Vanessa Kennedy
- Department of Haematology and Stem Cell Transplant, Stanford University, Stanford, CA, United States
| | - Hugues de Lavallade
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Donal Mclornan
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Victoria Potter
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Brian G Engelhardt
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Bipin Savani
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Wichai Chinratanalab
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Stacey Goodman
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - John Greer
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Adetola Kassim
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Sally York
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Michelle Kenyon
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Shreyans Gandhi
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Austin Kulasekararaj
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Judith Marsh
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Ghulam Mufti
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Antonio Pagliuca
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Madan Jagasia
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Kavita Raj
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
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21
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Day ME, Stimpson SJ, Rodeghier M, Ghafuri D, Callaghan M, Zaidi AU, Hannan B, Kassim A, James AH, DeBaun MR, Sharma D. Contraceptive Methods and the Impact of Menstruation on Daily Functioning in Women with Sickle Cell Disease. South Med J 2019; 112:174-179. [DOI: 10.14423/smj.0000000000000949] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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DeBaun MR, Ghafuri DL, Rodeghier M, Maitra P, Chaturvedi S, Kassim A, Ataga KI. Decreased median survival of adults with sickle cell disease after adjusting for left truncation bias: a pooled analysis. Blood 2019; 133:615-617. [PMID: 30530750 PMCID: PMC6367648 DOI: 10.1182/blood-2018-10-880575] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Nashville, TN
| | - Djamila L Ghafuri
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Nashville, TN
| | | | - Poulami Maitra
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Shruti Chaturvedi
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Adetola Kassim
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; and
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
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23
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Sharma D, Day ME, Stimpson SJ, Rodeghier M, Ghafuri D, Callaghan M, Zaidi AU, Hannan B, Kassim A, Zempsky W, Wellons M, James A, Bruehl S, DeBaun MR. Acute Vaso-Occlusive Pain is Temporally Associated with the Onset of Menstruation in Women with Sickle Cell Disease. J Womens Health (Larchmt) 2019; 28:162-169. [DOI: 10.1089/jwh.2018.7147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Deva Sharma
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa E. Day
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah-Jo Stimpson
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark Rodeghier
- Department of Pediatrics, Rodeghier Consultants, Chicago, Illinois
| | - Djamila Ghafuri
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Callaghan
- Department of Pediatrics, Wayne State University Medical Center, Detroit, Michigan
| | - Ahmar Urooj Zaidi
- Department of Pediatrics, Wayne State University Medical Center, Detroit, Michigan
| | - Bryan Hannan
- Department of Pediatrics, Wayne State University Medical Center, Detroit, Michigan
| | - Adetola Kassim
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William Zempsky
- Connecticut Children's Medical Center, Hartford, Connecticut
| | - Melissa Wellons
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andra James
- Department of Obstetrics and Gynecology, Duke Hemostasis and Thrombosis Center, Duke University, Durham, North Carolina
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael R. DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee
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Cronin RM, Hankins JS, Byrd J, Pernell BM, Kassim A, Adams-Graves P, Thompson A, Kalinyak K, DeBaun M, Treadwell M. Risk factors for hospitalizations and readmissions among individuals with sickle cell disease: results of a U.S. survey study. ACTA ACUST UNITED AC 2018; 24:189-198. [PMID: 30479187 PMCID: PMC6349225 DOI: 10.1080/16078454.2018.1549801] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Hospital admissions are significant events in the care of individuals with sickle cell disease (SCD) due to associated costs and potential for quality of life compromise. METHODS This cross-sectional cohort study evaluated risk factors for admissions and readmissions between October 2014 and March 2016 in adults with SCD (n = 201) and caregivers of children with SCD (n = 330) at six centres across the U.S. Survey items assessed social determinants of health (e.g. educational attainment, difficulty paying bills), depressive symptoms, social support, health literacy, spirituality, missed clinic appointments, and outcomes hospital admissions and 30-day readmissions in the previous year. RESULTS A majority of adults (64%) and almost half of children (reported by caregivers: 43%) were admitted, and fewer readmitted (adults: 28%; children: 9%). The most common reason for hospitalization was uncontrolled pain (admission: adults: 84%, children: 69%; readmissions: adults: 83%, children: 69%). Children were less likely to have admissions/readmissions than adults (Admissions: OR: 0.35, 95% CI: [0.23,0.52]); Readmissions: 0.23 [0.13,0.41]). For all participants, missing appointments were associated with admissions (1.66 [1.07, 2.58]) and readmissions (2.68 [1.28, 6.29]), as were depressive symptoms (admissions: 1.36 [1.16,1.59]; readmissions: 1.24 [1.04, 1.49]). In adults, difficulty paying bills was associated with more admissions, (3.11 [1.47,6.62]) readmissions (3.7 [1.76,7.79]), and higher spirituality was associated with fewer readmissions (0.39 [0.18,0.81]). DISCUSSION Missing appointments was significantly associated with admissions and readmissions. Findings confirm that age, mental health, financial insecurity, spirituality, and clinic attendance are all modifiable factors that are associated with admissions and readmissions; addressing them could reduce hospitalizations.
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Affiliation(s)
- Robert M Cronin
- a Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , TN , USA.,b Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.,c Department of Pediatrics , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Jane S Hankins
- d Department of Hematology , St Jude Children's Research Hospital , Memphis , TN , USA
| | - Jeannie Byrd
- e Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Brandi M Pernell
- e Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA.,f Department of Pediatrics, Division of Hematology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Adetola Kassim
- g Department of Hematology/Oncology , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Patricia Adams-Graves
- h Department of General Internal Medicine and Hematology , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Alexis Thompson
- i Department of Pediatrics, Department of Medicine , Northwestern University , Chicago , IL , USA
| | - Karen Kalinyak
- j Division of Hematology in Cancer and Blood Diseases Institute , University of Cincinnati , Cincinnati , OH , USA
| | - Michael DeBaun
- e Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Marsha Treadwell
- k Department of Hematology/Oncology , UCSF Benioff Children's Hospital Oakland , Oakland , CA , USA
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25
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Chaturvedi S, Ghafuri DL, Jordan N, Kassim A, Rodeghier M, DeBaun MR. Clustering of end-organ disease and earlier mortality in adults with sickle cell disease: A retrospective-prospective cohort study. Am J Hematol 2018; 93:1153-1160. [PMID: 29981283 DOI: 10.1002/ajh.25202] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/10/2023]
Abstract
Chronic end-organ complications result in morbidity and mortality in adults with sickle cell disease (SCD). In a retrospective-prospective cohort of 150 adults with SCD who received standard care screening for pulmonary function abnormalities, cardiac disease, and renal assessment from January 2003 to 2016, we tested the hypothesis that clustering of end-organ disease is common and multiple organ impairment predicts mortality. Any end-organ disease occurred in 59.3% of individuals, and 24.0% developed multiple organ (>1) end-organ disease. The number of end-organs affected was associated with mortality (P ≤ .001); 8.2% (5 of 61) of individuals with no affected end-organ, 9.4% (5 of 53) of those with 1 affected organ, 20.7% (6 of 29) of those with 2 affected end-organs, and 85.7% (6 of 7) with 3 affected end-organs died over a median follow up period of 8.7 (interquartile range 3.5-11.4) years. Of the 22 individuals who died, 77.3% had evidence of any SCD-related end-organ impairment, and this was the primary or secondary cause of death in 45.0%. SCD-related chronic impairment in multiple organs, and its association with mortality, highlights the need to understand the common mechanisms underlying chronic end-organ damage in SCD, and the urgent need to develop interventions to prevent irreversible end-organ complications in SCD.
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Affiliation(s)
- Shruti Chaturvedi
- Division of Hematology, Department of Medicine; Johns Hopkins University School of Medicine; Nashville Tennesse
| | | | - Natalie Jordan
- Vanderbilt-Meharry Sickle Cell Disease Center of Excellence; Nashville Tennesse
- Division of Hematology and Oncology, Department of Medicine; Vanderbilt University Medical Center; Nashville Tennessee
| | - Adetola Kassim
- Vanderbilt-Meharry Sickle Cell Disease Center of Excellence; Nashville Tennesse
- Division of Hematology and Oncology, Department of Medicine; Vanderbilt University Medical Center; Nashville Tennessee
| | | | - Michael R. DeBaun
- Vanderbilt-Meharry Sickle Cell Disease Center of Excellence; Nashville Tennesse
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville Tennesse
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26
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Cronin RM, Hankins JS, Byrd J, Pernell BM, Kassim A, Adams-Graves P, Thompson AA, Kalinyak K, DeBaun MR, Treadwell M. Modifying factors of the health belief model associated with missed clinic appointments among individuals with sickle cell disease. ACTA ACUST UNITED AC 2018; 23:683-691. [PMID: 29595096 DOI: 10.1080/10245332.2018.1457200] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Outpatient care is critical in the management of chronic diseases, including sickle cell disease (SCD). Risk factors for poor adherence with clinic appointments in SCD are poorly defined. This exploratory study evaluated associations between modifying variables from the Health Belief Model and missed appointments. METHODS We surveyed adults with SCD (n = 211) and caregivers of children with SCD (n = 331) between October 2014 and March 2016 in six centres across the U.S. The survey tool utilized the framework of the Health Belief Model, and included: social determinants, psychosocial variables, social support, health literacy and spirituality. RESULTS A majority of adults (87%) and caregivers of children (65%) reported they missed a clinic appointment. Children (as reported by caregivers) were less likely to miss appointments than adults (OR:0.22; 95% CI:(0.13,0.39)). In adults, financial insecurity (OR:4.49; 95% CI:(1.20, 20.7)), health literacy (OR:4.64; 95% CI:(1.33, 16.15)), and age (OR:0.95; 95% CI:(0.91,0.99)) were significantly associated with missed appointments. In all participants, lower spirituality was associated with missed appointments (OR:1.83; 95%CI:(1.13, 2.94)). The most common reason for missing an appointment was forgetfulness (adults: 31%, children: 26%). A majority thought reminders would help (adults: 83%, children: 71%) using phone calls (adults: 62%, children: 61%) or text messages (adults: 56%, children: 51%). CONCLUSIONS Our findings demonstrate that modifying components of the Health Belief Model, including age, financial security, health literacy, spirituality, and lacking cues to action like reminders, are important in missed appointments and addressing these factors could improve appointment-keeping for adults and children with SCD.
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Affiliation(s)
- Robert M Cronin
- a Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , TN , USA.,b Department of Internal Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.,c Department of Pediatrics , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Jane S Hankins
- d Department of Hematology , St Jude Children's Research Hospital , Memphis , TN , USA
| | - Jeannie Byrd
- e Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Brandi M Pernell
- e Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA.,f Department of Pediatrics, Division of Hematology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Adetola Kassim
- g Department of Hematology/Oncology , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Patricia Adams-Graves
- h Department of General Internal Medicine , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Alexis A Thompson
- i Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics , Northwestern University , Chicago , IL , USA
| | - Karen Kalinyak
- j Division of Hematology in Cancer and Blood Diseases Institute , University of Cincinnati , Cincinnati , OH , USA
| | - Michael R DeBaun
- e Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Marsha Treadwell
- k Department of Hematology/Oncology , UCSF Benioff Children's Hospital Oakland , Oakland , CA , USA
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Kumar SK, Callander NS, Alsina M, Atanackovic D, Biermann JS, Castillo J, Chandler JC, Costello C, Faiman M, Fung HC, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kang Y, Kassim A, Liedtke M, Malek E, Martin T, Neppalli VT, Omel J, Raje N, Singhal S, Somlo G, Stockerl-Goldstein K, Weber D, Yahalom J, Kumar R, Shead DA. NCCN Guidelines Insights: Multiple Myeloma, Version 3.2018. J Natl Compr Canc Netw 2018; 16:11-20. [DOI: 10.6004/jnccn.2018.0002] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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28
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Ogunsile FJ, Currie KL, Rodeghier M, Kassim A, DeBaun MR, Sharma D. History of parvovirus B19 infection is associated with silent cerebral infarcts. Pediatr Blood Cancer 2018; 65. [PMID: 28834316 DOI: 10.1002/pbc.26767] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The relationship between silent cerebral infarcts (SCIs) and history of parvovirus B19 (B19V) has not been systematically evaluated. As an ancillary study from the Silent Cerebral Infarct Trial (SIT) (NCT00072761), we tested the hypothesis that a history of B19V infection is associated with an increased prevalence of SCIs in children with sickle cell anemia. PROCEDURE We used a retrospective cross-sectional cohort study design; each participant underwent a brain magnetic resonance imaging (MRI) scan and medical record review for prior B19V infection (n = 958). RESULTS SCI was present in 30% (287 of 958) of participants and 17% (165 of 958) had a history of B19V infection. Based on prior evidence that low baseline hemoglobin (Hgb) levels are associated with increased odds of SCI, Hgb levels were divided into tertiles (<7.6 g/dl, ≥7.6-≤8.5 g/dl, ≥8.6 g/dl) and multivariable analysis was used to determine the relationship between the joint effect of prior B19V infection, Hgb levels, and SCI. Prior B19V infection and the lowest Hgb tertile were associated with increased risk of SCI (odds ratio [OR] 2.12; 95% CI, 1.17-3.84; P = 0.013); no prior B19V infection and the highest Hgb tertile were associated with a decreased risk (OR 0.56; 95% CI, 0.38-0.84; P = 0.004). CONCLUSIONS Efforts to decrease the incidence of B19V infection, such as the development of a B19V vaccine, may decrease SCI prevalence.
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Affiliation(s)
- Foluso J Ogunsile
- Division of Hematology/Oncology, Department of Medicine, Johns Hopkins University Medical Center, Baltimore, Maryland
| | - Kelli L Currie
- Department of Medicine and Pediatrics, Meharry Medical College, Nashville, Tennessee
| | | | - Adetola Kassim
- Department of Medicine and Pediatrics, Vanderbilt-Meharry Sickle Cell Center of Excellence, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael R DeBaun
- Department of Medicine and Pediatrics, Vanderbilt-Meharry Sickle Cell Center of Excellence, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Deva Sharma
- Department of Medicine and Pediatrics, Vanderbilt-Meharry Sickle Cell Center of Excellence, Vanderbilt University Medical Center, Nashville, Tennessee
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29
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Kumar SK, Callander NS, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Faiman M, Fung HC, Gasparetto C, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kassim A, Liedtke M, Martin T, Omel J, Raje N, Reu FJ, Singhal S, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Shead DA, Kumar R. Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017; 15:230-269. [PMID: 28188192 DOI: 10.6004/jnccn.2017.0023] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multiple myeloma (MM) is caused by the neoplastic proliferation of plasma cells. These neoplastic plasma cells proliferate and produce monoclonal immunoglobulin in the bone marrow causing skeletal damage, a hallmark of multiple myeloma. Other MM-related complications include hypercalcemia, renal insufficiency, anemia, and infections. The NCCN Multiple Myeloma Panel members have developed guidelines for the management of patients with various plasma cell dyscrasias, including solitary plasmacytoma, smoldering myeloma, multiple myeloma, systemic light chain amyloidosis, and Waldenström's macroglobulinemia. The recommendations specific to the diagnosis and treatment of patients with newly diagnosed MM are discussed in this article.
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30
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Kassim A, Zainal Z, Saravanan N, Vikneshwari R, Malathi S. Preparation and Studies of Electrodeposited CuSe Thin Films. Eurasian Chem Tech J 2017. [DOI: 10.18321/ectj598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cathodic electrodeposition in the presence of sodium dodecyl-sulphate in aqueous solution was used to prepare CuSe thin film deposited on titanium substrates. The effect of deposition potential, concentration<br />and deposition time were studied to determine the optimum condition for the electrodeposition process. The films were characterized by X-ray diffractrometry. Scanning electron microscopy was used to study<br />the morphology of the deposits. The photoresponse of the films prepared was analysed using linear sweep voltammetry in the presence of sodium thiosulphate.
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31
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Chaturvedi S, Labib Ghafuri D, Kassim A, Rodeghier M, DeBaun MR. Elevated tricuspid regurgitant jet velocity, reduced forced expiratory volume in 1 second, and mortality in adults with sickle cell disease. Am J Hematol 2017; 92:125-130. [PMID: 27806442 DOI: 10.1002/ajh.24598] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 12/23/2022]
Abstract
Cardiopulmonary disease is the leading cause of mortality in adults with sickle cell disease (SCD). Elevated tricuspid regurgitant jet velocity (TRJV) and reduced forced expiratory volume in 1 second (FEV1 ) %predicted are associated with early mortality in SCD; however their relationship and combined effect on survival is unknown. We investigated the relationship between TRJV and FEV1 %predicted, and their combined effect on mortality, in a retrospective cohort of 189 adults with SCD who underwent both pulmonary function testing and echocardiography. Nineteen (9.9%) of 189 patients died over a median follow-up of 1.4 years; cardiopulmonary disease was the major cause of death in 52.6%. FEV1 %predicted was negatively associated with TRJV (Spearman rho, -0.34, P < 0.001). Individuals with FEV1 %predicted ≤70% were more likely to have an elevated TRJV ≥2.5 m/second, compared to those with FEV1 %predicted >70% [45.8% versus 17.1%; odds ratio (OR) 4.1 (95% Confidence interval ([CI] 2.1-8.0); P = 0.001]. In a multivariable cox regression model, the combination of TRJV ≥2.5 m/second and FEV1 %predicted ≤70% predicted earlier mortality [hazard ratio (HR) 4.97 (95% CI 1.30-18.91; P = 0.019)] after adjusting for age, sex, and nephropathy. Both FEV1 %predicted ≤70% and TRJV ≥2.5 m/second were independently associated with nephropathy [OR 4.48 (95% CI 1.51-13.31); P = 0.004] and [OR 3.27 (95% CI 1.19-9.00); P = 0.017], respectively. In conclusion, pulmonary and cardiac impairment are associated with, and contribute to mortality in SCD. Therapies aimed at improving reduced FEV1 %predicted and elevated TRJV could improve survival in patients with SCD. Am. J. Hematol. 92:125-130, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Shruti Chaturvedi
- Division of Hematology and Oncology, Department of Medicine; Vanderbilt University; Nashville, Tennessee
| | | | - Adetola Kassim
- Division of Hematology and Oncology, Department of Medicine; Vanderbilt University; Nashville, Tennessee
- Vanderbilt-Meharry Sickle Cell Disease Center of Excellence; Nashville, Tennessee
| | | | - Michael R. DeBaun
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville, Tennessee
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32
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Cronin RM, Hankins JS, Adams-Graves P, Thompson AA, Kalinyak K, Byrd J, McClain B, Kassim A, DeBaun M, Treadwell M. Barriers and facilitators to research participation among adults, and parents of children with sickle cell disease: A trans-regional survey. Am J Hematol 2016; 91:E461-2. [PMID: 27421796 DOI: 10.1002/ajh.24483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Robert M. Cronin
- Department of Biomedical Informatics; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Internal Medicine; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville Tennessee
| | - Jane S. Hankins
- Department of Hematology; St Jude Children's Research Hospital; Memphis Tennessee
| | - Patricia Adams-Graves
- Department of General Internal Medicine; University of Tennessee Health Science Center; Memphis Tennessee
| | - Alexis A. Thompson
- Department of Pediatrics; Department of Medicine; Northwestern University; Chicago Illinois
| | - Karen Kalinyak
- Division of Hematology in Cancer and Blood Disease Institute; Cincinnati Children's Hospital; Cincinnati Ohio
| | - Jeannie Byrd
- Department of Pediatrics; Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Brandi McClain
- Department of Pediatrics; Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Adetola Kassim
- Department of Medicine; Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Michael DeBaun
- Department of Pediatrics; Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Marsha Treadwell
- Department of Hematology/Oncology; UCSF Benioff Children's Hospital Oakland; Oakland California
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33
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Kassim A, Workneh TS, Laing MD, Basdew IH. The effects of different pre-packaging treatments on the quality of kumquat fruit. CyTA - Journal of Food 2016. [DOI: 10.1080/19476337.2016.1190407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A. Kassim
- Bioresources Engineering, School of Engineering, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Private Bag X01, Pietermaritzburg, Scottsville 3209, South Africa
| | - T. S. Workneh
- Bioresources Engineering, School of Engineering, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Private Bag X01, Pietermaritzburg, Scottsville 3209, South Africa
| | - M. D. Laing
- Discipline of Plant Pathology, School of Agricultural, Earth and Environmental Science, University of KwaZulu-Natal, Private Bag X01, Pietermaritzburg, Scottsville 3209, South Africa
| | - I. H. Basdew
- Discipline of Plant Pathology, School of Agricultural, Earth and Environmental Science, University of KwaZulu-Natal, Private Bag X01, Pietermaritzburg, Scottsville 3209, South Africa
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34
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Sanger M, Jordan L, Pruthi S, Day M, Covert B, Merriweather B, Rodeghier M, DeBaun M, Kassim A. Cognitive deficits are associated with unemployment in adults with sickle cell anemia. J Clin Exp Neuropsychol 2016; 38:661-71. [DOI: 10.1080/13803395.2016.1149153] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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35
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Anderson KC, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Djulbegovic B, Fung HC, Gasparetto C, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kassim A, Krishnan AY, Kumar SK, Liedtke M, Lunning M, Raje N, Reu FJ, Singhal S, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Shead DA, Kumar R. NCCN Guidelines Insights: Multiple Myeloma, Version 3.2016. J Natl Compr Canc Netw 2016; 14:389-400. [PMID: 27059188 PMCID: PMC6016087 DOI: 10.6004/jnccn.2016.0046] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
These NCCN Guidelines Insights highlight the important updates/changes specific to the 2016 version of the NCCN Clinical Practice Guidelines in Oncology for Multiple Myeloma. These changes include updated recommendations to the overall management of multiple myeloma from diagnosis and staging to new treatment options.
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Affiliation(s)
| | | | | | | | - Jason C Chandler
- St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | - Kelly Godby
- University of Alabama at Birmingham Comprehensive Cancer Center
| | - Craig Hofmeister
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Leona Holmberg
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Carol Ann Huff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | - Noopur Raje
- Massachusetts General Hospital Cancer Center
| | - Frederic J Reu
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Seema Singhal
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Donna Weber
- The University of Texas MD Anderson Cancer Center
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36
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Halasa NB, Savani BN, Asokan I, Kassim A, Simons R, Summers C, Bourgeois J, Clifton C, Vaughan LA, Lucid C, Wang L, Fonnesbeck C, Jagasia M. Randomized Double-Blind Study of the Safety and Immunogenicity of Standard-Dose Trivalent Inactivated Influenza Vaccine versus High-Dose Trivalent Inactivated Influenza Vaccine in Adult Hematopoietic Stem Cell Transplantation Patients. Biol Blood Marrow Transplant 2016; 22:528-35. [DOI: 10.1016/j.bbmt.2015.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 12/02/2015] [Indexed: 01/04/2023]
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37
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Jordan LC, Gindville M, Scott A, Strother MK, Kassim A, Chen SC, Pruthi S, Shyr Y, Donahue MJ. Abstract WP417: Oxygen Extraction Fraction Measured With MRI is Reduced After Blood Transfusion in Adults With Sickle Cell Anemia. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Blood transfusion for primary stroke prevention is well established in children but not adults with sickle cell anemia (SCA). Secondary stroke prevention in young adults with SCA is generally accepted. However blood transfusion therapy does not prevent all infarcts and recurrent assessment of cerebral physiology is likely necessary to portend stroke risk.
Hypothesis:
Oxygen extraction fraction (OEF), which reflects the balance of oxygen consumed to oxygen delivered, can be evaluated routinely noninvasively
in vivo
using MRI and reduces following blood transfusion; if confirmed, routine MRI-based OEF screening could be applied to evaluate impact of blood transfusion and other therapies on tissue-level impairment.
Methods:
The noninvasive T
2
-relaxation-under-spin-tagging (TRUST)-MRI method (duration=1min12s) was applied in adults with SCA (n=5) and age and race-matched control (n=11) volunteers. SCA volunteers were scanned pre- and post-transfusion and controls at two time points to assess healthy OEF reproducibility and hypothesized changes after transfusion, respectively. OEF changes were contrasted with symptoms, vasculopathy, and perfusion. A Kruskal-Wallis test with two-sided p<0.05 was used to evaluate significant differences.
Results:
In adults with SCA, mean age 33±3 years (y) OEF was significantly elevated (p<0.01, OEF=0.53±0.09) relative to controls (mean age 27±5y, OEF=0.32±0.06). OEF was not significantly different at follow-up for controls (OEF=0.33±0.05), but was reduced (OEF=0.44±0.05; p=0.021) following transfusion in SCA volunteers (Figure). Reduction in OEF is inversely correlated with increase in hematocrit post-transfusion.
Conclusion:
Noninvasive MRI can quickly detect expected reductions in OEF after blood transfusion. Ongoing work is focused on understanding relationships between OEF, changes in symptomatology and stroke risk in SCA. OEF has been predictive of stroke risk in other patient groups.
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Affiliation(s)
| | | | | | | | | | | | | | - Yu Shyr
- Vanderbilt Univ Sch of Medicine, Nashville, TN
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38
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Jordan LC, Gindville M, Scott A, Strother MK, Kassim A, Chen SC, Pruthi S, Shyr Y, Donahue MJ. Abstract TMP93: Elevated Oxygen Extraction Fraction Measured With Noninvasive MRI may be Discriminatory for Stroke Risk in Adults With Sickle Cell Anemia. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tmp93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
No screening procedures exist for evaluating stroke risk in adults with sickle cell anemia (SCA). Reduced oxygen carrying capacity is present in SCA, which may initially be compensated for by an increase in cerebral blood flow (CBF) and then by increased oxygen extraction fraction (OEF).
Hypothesis:
OEF and CBF can be measured noninvasively and reproducibly with MRI using clinically-available equipment in adults with SCA; elevated OEF provides added discriminatory capacity for clinical impairment relative to vasculopathy extent and CBF alone.
Methods:
Structural, CBF-weighted, and MRA imaging, together with a noninvasive OEF-weighted T
2
-relaxation-under-spin-tagging (TRUST)-MRI method was applied in SCA adults (n=26) and race and age-matched controls (n=11). A Kruskal-Wallis test was applied to evaluate mean differences between SCA and control parameters. Linear regression assessed how elevated OEF correlated with increasing clinical impairment defined by presence of infarct, vasculopathy, or use of regular blood transfusions for SCA.
Results:
OEF had high reproducibility within the same scan session, n=37 (ICC = 0.989). Whole-brain OEF and CBF were increased in SCA adults (OEF=0.46±0.08; CBF=52.4±8.3 ml/100g/min) versus controls (OEF=0.35±0.06; CBF=43.6±5.1 ml/100g/min). Hematocrit and OEF were inversely correlated (R
2
=0.72; p<0.01). Linear regression revealed a stronger relationship of OEF than CBF with clinical impairment. In SCA adults without impairment (n=12) CBF and OEF have an inverse relationship (R
2
=0.41; p=0.01, Fig. 1A) but with clinical impairment (infarct, vasculopathy or severe pain requiring regular transfusions, n=14) CBF and OEF become uncoupled (R
2
=0.08; p=0.16; Fig. 1B) as CBF may not be able to increase further and may plateau or decline.
Conclusion:
TRUST-MRI OEF is a rapid, reproducible measure. OEF shows promise as screening tool for hemodynamic impairment and stroke risk in adults with SCA.
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Affiliation(s)
| | | | | | | | | | | | | | - Yu Shyr
- Vanderbilt Univ Med Cntr, Nashville, TN
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39
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Anderson KC, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Djulbegovic B, Fung HC, Gasparetto C, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kassim A, Krishnan AY, Kumar SK, Liedtke M, Lunning M, Raje N, Singhal S, Smith C, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Shead DA, Kumar R. Multiple Myeloma, Version 2.2016: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2015; 13:1398-435. [PMID: 26553768 PMCID: PMC4891187 DOI: 10.6004/jnccn.2015.0167] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. Recent statistics from the American Cancer Society indicate that the incidence of MM is increasing. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) included in this issue address management of patients with solitary plasmacytoma and newly diagnosed MM.
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40
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Hari P, Cornell R, Zhang M, Huang J, Kassim A, Costa L, Innis-Shelton R, Mark T, Nieto Y, Gasparetto C, Krishnan A, D’Souza A. Induction regimens for autologous transplant (AHCT) eligible myeloma (MM) patients (pts) – Doublets or Triplets and Which Triplet? Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Decker I, Ukaegbu O, Goodman S, Lenihan DJ, Phillips S, Hoffman R, Horst S, Hung R, Kassim A, Lacy S, Langone A, McDonagh KT, Rawling K, Rubinstein S, Steele M, Cornell RF. Functional improvement measured by the six-minute walk test after chemotherapy in cardiac AL amyloidosis. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e19539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ilka Decker
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Sara Horst
- Vanderbilt University Medical Center, Nashville, TN
| | - Rebecca Hung
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Shelton Lacy
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Kyle Rawling
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Mark Steele
- Vanderbilt University Medical Center, Nashville, TN
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42
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Das-Gupta E, Greinix H, Jacobs R, Zhou L, Savani BN, Engelhardt BG, Kassim A, Worel N, Knobler R, Russell N, Jagasia M. Extracorporeal photopheresis as second-line treatment for acute graft-versus-host disease: impact on six-month freedom from treatment failure. Haematologica 2014; 99:1746-52. [PMID: 25150260 DOI: 10.3324/haematol.2014.108217] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Second-line therapy for corticosteroid-refractory or -dependent acute graft-versus-host disease remains ill-defined, due to limited efficacy of drugs and evolving clinical trial endpoints. Six-month freedom from treatment failure has been proposed as a novel clinical trial endpoint and is defined by the absence of death, malignancy relapse/progression, or addition of a next line of systemic immunosuppressive therapy within 6 months of intervention and prior to diagnosis of chronic graft-versus-host disease. We analyzed the 6-month freedom from treatment failure endpoint in 128 patients enrolled from three centers who were treated with extracorporeal photopheresis as second-line therapy for acute graft-versus-host disease. The incidence of 6-month freedom from treatment failure was 77.3% with a 2-year survival rate of 56%. Corticosteroid dose or response status at onset of second-line therapy did not influence outcome. Higher grade of acute graft-versus-host disease (grade 2 versus grades 3-4) at onset of photopheresis predicted for poor outcome as measured by survival (hazard ratio 2.78, P<0.001), non-relapse mortality (hazard ratio 2.78, P=0.001) and 6-month freedom from treatment failure (hazard ratio 3.05, P<0.001). For the 91 patients who achieved 6-month freedom from treatment failure, 1-year, 2-year and 3-year survival rates were 78.9%, 70.8% and 69.5%, respectively. Six-month freedom from treatment failure is a reasonable early surrogate for outcome and should be considered as a clinical trial endpoint. This study demonstrates the durable effect of photopheresis as second-line therapy for corticosteroid-refractory or -dependent acute graft-versus-host disease using 6-month freedom from treatment failure as the primary endpoint.
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Affiliation(s)
| | | | - Ryan Jacobs
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li Zhou
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bipin N Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian G Engelhardt
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adetola Kassim
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Madan Jagasia
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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43
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Othman N, Talib ZA, Kassim A, Shaari AH, Liew J. Electrical Properties of Polypyrrole Conducting Polymer at Various Dopant Concentrations. Mal J Fund Appl Sci 2014. [DOI: 10.11113/mjfas.v5n1.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Polypyrrole conducting polymer was prepared by chemical reaction method with various concentrations of iron (III) chloride (FeCl3) as dopant. The dc conductivity was obtained from current-voltage characteristic by using parallel-plate techniques in the temperature range of 100-300K. With the involvement of chloride, Cl- in the polymeric chain, the conductivity increased as temperature and the dopant concentration increased. To describe the electrical transport process, Mott’s 1-D, 2-D and 3-D variable range hopping (VRH) models have been considered. The result gives evidence of transport mechanism based on Mott’s 3-D VRH mechanism for all various dopant concentrations studied.
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44
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Pauff JM, Gonzalez RS, Sajnani KP, Kassim A, Jagasia M. Post-allograft pomalidomide and reversible hepatotoxicity. Bone Marrow Transplant 2014; 49:1341-2. [DOI: 10.1038/bmt.2014.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vaughan LA, Vu M, Sengsayadeth S, Lucid C, Clifton C, Mccarty K, Hagaman D, Domm J, Kassim A, Chinratanalab W, Goodman S, Greer J, Frangoul H, Engelhardt BG, Jagasia M, Savani BN. New allergies after cord blood transplantation. Cytotherapy 2013; 15:1259-65. [DOI: 10.1016/j.jcyt.2013.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 05/16/2013] [Accepted: 05/24/2013] [Indexed: 02/08/2023]
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Jagasia M, Greinix H, Robin M, Das-Gupta E, Jacobs R, Savani BN, Engelhardt BG, Kassim A, Worel N, Knobler R, Russell N, Socie G. Extracorporeal Photopheresis versus Anticytokine Therapy as a Second-Line Treatment for Steroid-Refractory Acute GVHD: A Multicenter Comparative Analysis. Biol Blood Marrow Transplant 2013; 19:1129-33. [DOI: 10.1016/j.bbmt.2013.04.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/18/2013] [Indexed: 11/29/2022]
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Kassim A, McDuffie JS, Mosse CA, Savani BN, Greer JP, Oluwole OO, Goodman S, Engelhardt BG, Chinratanalab W, Kim AS, Jagasia MH. Minimal residual disease (MRD) status pre- and post- high-dose therapy/autologous stem (HDC/ASCT) cell transplantation for multiple myeloma (MM) in the era of novel agents. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.8605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8605 Background: MRD assayed by multi-parameter flow cytometer (MFC), has prognostic significance after HDT/ASCT for MM (Paiva et. al. 2008). The frequency of MRD negativity (-) after induction therapy using novel agents such as immunomodulatory drugs like lenalidomide (IMiDs), and proteasome inhibitors like bortezomib, is unknown. The impact of HDT/ASCT on MRD status in this patient group has not been studied. Methods: We performed a retrospective study of all MM patients undergoing HDT/ASCT (January 2010 - December 2012) in our institution. No restrictions on inclusion were made based on the International Myeloma Working Group response criteria. All patients had novel agents as part of their initial induction regimen. Statistical analysis was by SPSS software (V 12.0). MRD status was determined by MFC on bone marrow samples pre- HDC/ASCT [M1] and post- HDC/ASCT (D100 [M2] and I year [M3]). MFC was done with antibodies against CD45, CD19, CD138, CD38, CD20, CD56, and anti-k and l cytoplasmic antibodies. Results: MRD status was available on 91 patients pre-transplant. Of these patients, 80 had MFC recorded at M2 and 17 patients had MFC recorded at M3. Fifty-eight percent were male and 76% were Caucasian. Forty percent received IMiDs, while 60% got proteasome based therapies. Of the 91 patients with MRD pre-HDC/ASCT, 58% (53/91) were MRD (-), and of these patients 89% (41/46) remained MRD (-) at M2. 48 patients were MRD positive (+) pre-HDC/ASCT, 58% (20/34) became MRD (-) at M2. Age, cytogenetic risk, disease stage, number of chemotherapy cycles or immunofixation status had no impact on MRD status. There were only 6 relapses in the cohort, thus the impact of MRD status on progression-free survival could not be studied. Conclusions: Novel agents improve depth of response pre-transplant. HDC/ASCT increases MRD negativity post-transplant. MRD status could aid better timing of HDC/ASCT or adoption of a risk-adapted strategy for high-risk patients. MRD status validation in a prospective cohort is underway at our center (NCT01215344). With future follow-up, the impact of MRD on progression-free survival in the era of novel agents will be determined.
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McDuffie JS, Savani BN, Chinratanalab W, Goodman S, Greer JP, Oluwole OO, Engelhardt BG, Jagasia MH, Kassim A. Early lymphocyte recovery (ELR) impact on disease outcome following autologous hematopoietic stem cell transplantation (HDT/ASCT) for multiple myeloma (MM) in the era of novel agents. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e19539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19539 Background: Absolute lymphocyte count (ALC) > 500 cells/ µL on day 15 (ELR+) after HDT/ASCT, has been reported to be an independent prognostic indicator, for improved OS and PFS in patients with MM. Novel agents (immunomodulatory drugs (IMiDs) and proteasome inhibitors), mediate there effect through T-cell stimulation, NK cell activation, anti-proliferation, and are now main stay of therapy for MM. We sought to determine their effects on ELR, and correlated to disease outcome. Methods: A retrospective review of all MM patients seen at our institution undergoing HDT/ASCT from January 2008 to December 2012 was performed. Patients were identified from our CIBMTR database. ALC was determined pre-HDT/ASCT (T1), on day15 (T2) and d30 (T3) post-HDC/ASCT. No restrictions on inclusion were made based upon the International Myeloma Working Group response criteria. All had novel agents as part of their initial induction regimen. Disease response was determined by standard clinical and laboratory CIBMTR response criteria, and minimal residual disease status (MRD) by multiparameter flow cytometry. Results: In our study (n= 184), 52/184 patients had ELR+ while 132/184 had ALC < 500 cells/mL (ELR-) at T2. 21% received IMiDs, 33% proteasome inhibitor and 46% combination therapies. 52% of the ELR+ patients were MRD negative (-) at T1, and improved to 74% and 89% at D100, and 1 year post-HDC/ASCT respectively. Similarly 63%, 70%, and 80% of the ELR- patients, were MRD (-) at similar time-points. Chi squared analysis showed no significant difference in rates of MRD (-) based on ELR. ELR also had no impact on disease status as determined by CIBMTR response criteria, or 1 year PFS and OS (p = 0.383), (p = 0.577) respectively. Multivariate analyses, using cox-regression showed no impact of ALC at T1, T2, T3, age, sex, race, cytogenetic risk, or disease stage on disease outcome. Conclusions: Novel agents improve disease control independent of ELR following HDC/ASCT. Understanding their biologic effect on immune-reconstitution will provide a platform for adoptive immunotherapy to better target minimal residual disease.
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Gani SSA, Basri M, Rahman MBA, Kassim A, Salleh AB, Abdul Rahman RNZR, Ismail Z. Phase Behavior of Engkabang Fat with Nonionic Surfactants. TENSIDE SURFACT DET 2013. [DOI: 10.3139/113.110023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Phase behavior of engkabang fat was determined through the construction of ternary phase diagrams using nonionic surfactants. Several phase regions appeared in the ternary phase diagrams such as isotropic, homogenous, liquid crystal, two phase and three phase regions. The increase of hydrophilic-lipophilic balance (HLB) values of the nonionic surfactants used gave larger isotropic and homogenous region in the ternary phase diagrams. The combination of engkabang fat:Solubilisant Gamma (2:1) in the ternary phases diagram gave an even larger isotropic and homogenous regions as well as the formation of liquid crystal region.
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Affiliation(s)
- S. S. A. Gani
- Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - M. Basri
- Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - M. B. A. Rahman
- Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - A. Kassim
- Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - A. B. Salleh
- Faculty of Biotechnology and Biomolecular Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - R. N. Z. R. Abdul Rahman
- Faculty of Biotechnology and Biomolecular Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Z. Ismail
- Sime Darby Plantation Sdn. Bhd., Lot 2664, Jalan Pulau Carey, PO Box 207, 42700 Banting, Selangor, Malaysia
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Anderson KC, Alsina M, Bensinger W, Biermann JS, Cohen AD, Devine S, Djulbegovic B, Faber EA, Gasparetto C, Hernandez-Illizaliturri F, Huff CA, Kassim A, Krishnan AY, Liedtke M, Meredith R, Raje N, Schriber J, Singhal S, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Yunus F, Shead DA, Kumar R. Multiple Myeloma, Version 1.2013. J Natl Compr Canc Netw 2013; 11:11-7. [PMID: 23307977 DOI: 10.6004/jnccn.2013.0004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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