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Murthy HS, Zhang MJ, Chen K, Ahmed S, Deotare U, Ganguly S, Kansagra A, Michelis FV, Nishihori T, Patnaik M, Abid MB, Aljurf M, Arai Y, Bacher U, Badar T, Badawy SM, Ballen K, Battiwalla M, Beitinjaneh A, Bejanyan N, Bhatt VR, Brown VI, Martino R, Cahn JY, Castillo P, Cerny J, Chhabra S, Copelan E, Daly A, Dholaria B, Diaz Perez MA, Freytes CO, Grunwald MR, Hashmi S, Hildebrandt GC, Jamy O, Joseph J, Kanakry CG, Khera N, Krem MM, Kuwatsuka Y, Lazarus HM, Lekakis LJ, Liu H, Modi D, Munshi PN, Mussetti A, Palmisiano N, Patel SS, Rizzieri DA, Seo S, Shah MV, Sharma A, Sohl M, Solomon SR, Ulrickson M, Ustun C, van der Poel M, Verdonck LF, Wagner JL, Wang T, Wirk B, Zeidan A, Litzow M, Kebriaei P, Hourigan CS, Weisdorf DJ, Saber W, Kharfan-Dabaja MA. Allogeneic hematopoietic cell transplantation for blastic plasmacytoid dendritic cell neoplasm: a CIBMTR analysis. Blood Adv 2023; 7:7007-7016. [PMID: 37792849 PMCID: PMC10690553 DOI: 10.1182/bloodadvances.2023011308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/08/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy with a poor prognosis and considered incurable with conventional chemotherapy. Small observational studies reported allogeneic hematopoietic cell transplantation (allo-HCT) offers durable remissions in patients with BPDCN. We report an analysis of patients with BPDCN who received an allo-HCT, using data reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). We identified 164 patients with BPDCN from 78 centers who underwent allo-HCT between 2007 and 2018. The 5-year overall survival (OS), disease-free survival (DFS), relapse, and nonrelapse mortality (NRM) rates were 51.2% (95% confidence interval [CI], 42.5-59.8), 44.4% (95% CI, 36.2-52.8), 32.2% (95% CI, 24.7-40.3), and 23.3% (95% CI, 16.9-30.4), respectively. Disease relapse was the most common cause of death. On multivariate analyses, age of ≥60 years was predictive for inferior OS (hazard ratio [HR], 2.16; 95% CI, 1.35-3.46; P = .001), and higher NRM (HR, 2.19; 95% CI, 1.13-4.22; P = .02). Remission status at time of allo-HCT (CR2/primary induction failure/relapse vs CR1) was predictive of inferior OS (HR, 1.87; 95% CI, 1.14-3.06; P = .01) and DFS (HR, 1.75; 95% CI, 1.11-2.76; P = .02). Use of myeloablative conditioning with total body irradiation (MAC-TBI) was predictive of improved DFS and reduced relapse risk. Allo-HCT is effective in providing durable remissions and long-term survival in BPDCN. Younger age and allo-HCT in CR1 predicted for improved survival, whereas MAC-TBI predicted for less relapse and improved DFS. Novel strategies incorporating allo-HCT are needed to further improve outcomes.
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Affiliation(s)
- Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Mei-Jie Zhang
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Karen Chen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sairah Ahmed
- Department of Lymphoma/Myeloma and Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Uday Deotare
- London Health Sciences Centre, Toronto, ON, Canada
| | | | - Ankit Kansagra
- Blood and Marrow Transplant Program, UT Southwestern Medical Center, Dallas, TX
| | - Fotios V Michelis
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Muhammad Bilal Abid
- Divisions of Hematology/Oncology & Infectious Diseases, Bone and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Yasuyuki Arai
- Kyoto University Hospital, Kyoto University, Kyoto, Japan
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Talha Badar
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Karen Ballen
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | | | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Valerie I Brown
- Division of Pediatric Oncology/Hematology, Department of Pediatrics, Penn State Hershey Children's Hospital and College of Medicine, Hershey, PA
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Paul Castillo
- UF Health Shands Children's Hospital, Gainesville, FL
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA
| | - Saurabh Chhabra
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, AB, Canada
| | | | - Miguel Angel Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - César O Freytes
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jacinth Joseph
- Methodist Healthcare Blood and Marrow Transplant Center, Memphis, TN
| | - Christopher G Kanakry
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Lazaros J Lekakis
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Hongtao Liu
- Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL
| | - Dipenkumar Modi
- Division of Oncology, Karmanos Cancer Center/Wayne State University, Detroit, MI
| | - Pashna N Munshi
- Stem Cell Transplant and Cellular Immunotherapy Program, MedStar Georgetown University Hospital, Washington, DC
| | - Alberto Mussetti
- Clinical Hematology Department, Catalan Institute of Oncology, Hospitalet, Barcelona, Spain
- Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Neil Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Sagar S Patel
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | | | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | | | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN
| | - Melhm Sohl
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA
| | - Scott R Solomon
- Blood and Marrow Transplant Program, Northside Hospital Cancer Institute, Atlanta, GA
| | | | - Celalettin Ustun
- Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, IL
| | - Marjolein van der Poel
- Division of Hematology, Department of Internal Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - John L Wagner
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Trent Wang
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | - Amer Zeidan
- Bridgeport Hospital, Yale University School of Medicine, New Haven, CT
| | | | - Partow Kebriaei
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Daniel J Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
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Hansen DK, Sidana S, Peres LC, Colin Leitzinger C, Shune L, Shrewsbury A, Gonzalez R, Sborov DW, Wagner C, Dima D, Hashmi H, Kocoglu MH, Atrash S, Simmons G, Kalariya N, Ferreri C, Afrough A, Kansagra A, Voorhees P, Baz R, Khouri J, Alsina M, McGuirk J, Locke FL, Patel KK. Idecabtagene Vicleucel for Relapsed/Refractory Multiple Myeloma: Real-World Experience From the Myeloma CAR T Consortium. J Clin Oncol 2023; 41:2087-2097. [PMID: 36623248 PMCID: PMC10082273 DOI: 10.1200/jco.22.01365] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Idecabtagene vicleucel (ide-cel) is an autologous B-cell maturation antigen-directed chimeric antigen receptor T-cell therapy approved for relapsed/refractory multiple myeloma (RRMM) on the basis of the phase II pivotal KarMMa trial, which demonstrated best overall and ≥ complete response rates of 73% and 33%, respectively. We report clinical outcomes with standard-of-care (SOC) ide-cel under the commercial Food and Drug Administration label. METHODS Data were retrospectively collected from patients with RRMM who underwent leukapheresis as of February 28, 2022, at 11 US institutions with intent to receive SOC ide-cel. Toxicities were graded per American Society for Transplantation and Cellular Therapy guidelines and managed according to each institution's policies. Responses were graded on the basis of the International Myeloma Working Group response criteria. RESULTS One hundred fifty-nine of 196 leukapheresed patients received ide-cel by data cutoff. One hundred twenty (75%) infused patients would have been ineligible for participation in the KarMMa clinical trial because of comorbidities at the time of leukapheresis. Any grade and grade ≥ 3 cytokine release syndrome and neurotoxicity occurred in 82/3% and 18/6%, respectively. Best overall and ≥ complete response rates were 84% and 42%, respectively. At a median follow-up of 6.1 months from chimeric antigen receptor T infusion, the median progression-free survival was 8.5 months (95% CI, 6.5 to not reached) and the median overall survival was 12.5 months (95% CI, 11.3 to not reached). Patients with previous exposure to B-cell maturation antigen-targeted therapy, high-risk cytogenetics, Eastern Cooperative Oncology Group performance status ≥ 2 at lymphodepletion, and younger age had inferior progression-free survival on multivariable analysis. CONCLUSION The safety and efficacy of ide-cel in patients with RRMM in the SOC setting were comparable with those in the phase II pivotal KarMMa trial despite most patients (75%) not meeting trial eligibility criteria.
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Affiliation(s)
- Doris K. Hansen
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Surbhi Sidana
- Stanford University School of Medicine, Stanford, CA
| | - Lauren C. Peres
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Leyla Shune
- The University of Kansas Medical Center, Kansas City, KS
| | | | | | - Douglas W. Sborov
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Charlotte Wagner
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Danai Dima
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - Hamza Hashmi
- Medical University of South Carolina, Charleston, SC
| | - Mehmet H. Kocoglu
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | | | - Gary Simmons
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA
| | - Nilesh Kalariya
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Aimaz Afrough
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Ankit Kansagra
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | | | - Rachid Baz
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Jack Khouri
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - Melissa Alsina
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Joseph McGuirk
- The University of Kansas Medical Center, Kansas City, KS
| | | | - Krina K. Patel
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Lin M, Pezzin LE, Mohamedi A, Kansagra A, D'Souza A. Prevalence of Race/Ethnicity Reporting in Light Chain (AL) Amyloidosis Clinical Research in the USA. J Racial Ethn Health Disparities 2023; 10:644-650. [PMID: 35106741 PMCID: PMC9339584 DOI: 10.1007/s40615-022-01252-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/03/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
Little is known about racial differences in the incidence of light chain (AL) amyloidosis despite the well-documented racial disparities in the epidemiology of other plasma cell disorders. The goal of this study was to examine the extent to which published clinical research in AL amyloidosis report information on patients' race. Clinical research publications in AL amyloidosis between January 1, 2010, and December 31, 2020, from the USA were identified. In addition to the reporting of race, study design, funding, cohort size, year of publication, impact factor of publication journal, and first author degree were abstracted. Among papers reporting race, we also assessed whether ethnicity was reported separately. A PubMed search yielded 2,770 papers of which 220 met the pre-specified criteria for analysis. Of those, 37 (16.5%) reported race. Single institution publications, those with physicians as first authors, and those published in journals with impact factor 6 or higher were less likely to report race. On multivariate analysis, only single institution studies were negatively associated with race reporting. Of the 37 papers reporting race, none defined it in methods, 16% stated how race was identified, and 19% discussed its significance. Ethnicity was reported in 6 studies. Our results indicate that race/ethnicity is underreported in USA. AL amyloidosis clinical literature leads to a challenge for identifying potential racial/ethnic disparities. Standards for collecting and reporting racial/ethnic demographics are needed. Clear and consistent reporting of race and ethnicity of clinical populations is a necessary first step in identifying disparities and promoting equitable care.
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Affiliation(s)
- Mingqian Lin
- Medical College of Wisconsin, Milwaukee, WI, 53005, USA
| | | | - Ali Mohamedi
- University of Texas Southwestern, Dallas, TX, USA
| | | | - Anita D'Souza
- Medical College of Wisconsin, Milwaukee, WI, 53005, USA.
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Singhal S, Saadeh SS, Durani U, Kansagra A, Alkhateeb HB, Shah MV, Mangaonkar A, Kenderian S, Hashmi S, Patnaik MV, Litzow MR, Hogan WJ. Allogeneic Hematopoietic Stem Cell Transplantation in the Outpatient Setting: The Mayo Clinic Experience. Transplant Cell Ther 2023; 29:183.e1-183.e6. [PMID: 36584940 DOI: 10.1016/j.jtct.2022.12.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Hematopoietic stem cell transplantations (HSCT) are intensive and potentially curative modalities available for a variety of hematological diseases. Although alloHSCTs are typically performed in an inpatient setting, there has been increasing interest in moving them to the outpatient setting. AlloHSCTs are associated with a median length of hospital stay of 30 days. AlloHSCTs in the inpatient setting may increase patient exposure to nosocomial infections, drug-resistant organisms, rapid deconditioning with time spent in hospital beds, and loss of muscle mass. In this study, we aim to share outcomes of 856 consecutive alloHSCTs done in our institute over the past 2 decades. This is a single-center retrospective chart review encompassing 856 patients who underwent outpatient alloHSCTs between 2000 and 2017. Reduced-intensity conditioning, stem cell infusion, and much of the immediate follow-up in the early alloHSCT period was performed on an outpatient basis with daily evaluation, laboratory assessment, and intervention as needed. Rate of non-routine hospital admission was our primary outcome of interest. We also looked at various secondary outcomes, including causes of admission, median length of stay, and in-hospital mortality rate. Data analysis was performed using STATA statistical software Version 15. Descriptive statistics were used to summarize baseline demographic data and outcomes. Logistic regression modeling was used to identify predictors of hospital admission. We observed that about one third of our cohort never required admission to the hospital throughout the first 100 days after HSCT. Among those admitted, 6.6% experienced a direct admission to the intensive care unit, and the overall in hospital mortality was low at 5%. Furthermore, the median length of stay was noted to be decreased at 6 days compared to a median reported 30 days in existing literature. Overall, we observed favorable safety profile and outcomes with outpatient management of HSCTs.
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Affiliation(s)
- Sachi Singhal
- Department of Internal Medicine, Crozer-Chester Medical Center, Upland, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Salwa S Saadeh
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Urshila Durani
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Ankit Kansagra
- Department of Internal Medicine, UT Southwestern Medical Center, Texas
| | | | - Mithun V Shah
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Saad Kenderian
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Shahrukh Hashmi
- Department of Hematology, Mayo Clinic, Rochester, Minnesota; Department of Hematology/Oncology, Sheikh Shakhbout Medical City/ Mayo Clinic, Abu Dhabi
| | | | - Mark R Litzow
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
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Kapinos KA, Hu E, Trivedi J, Geethakumari PR, Kansagra A. Cost-Effectiveness Analysis of CAR T-Cell Therapies vs Antibody Drug Conjugates for Patients with Advanced Multiple Myeloma. Cancer Control 2023; 30:10732748221142945. [PMID: 36651055 PMCID: PMC9869188 DOI: 10.1177/10732748221142945] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Among advanced multiple myeloma (MM) patients, B-cell maturation antigen (BCMA) specific targets like Belantamab Mafodotin (belamaf) and CAR T-cell therapies have been shown to improve clinical outcomes, but at significant costs. To compare the expected costs per quality-adjusted life years (QALYs) gained among a hypothetical cohort of triple refractory MM patients treated with one of three BCMA-directed therapies: (1) idecabtagene vicleucel (ide-cel), (2) ciltacabtagene autoleucel (cilta-cel), and (3) belamaf for up to 20 months. METHODS In this cost-effectiveness analysis, we built a Monte Carlo Markov Chain microsimulation model using estimates and parameters from the evidence on MM treatment for 10 000 hypothetical patients between the ages for 40 and 80. We assigned expected years of life remaining and made varying assumptions about survival beyond 5 years. RESULTS We predicted total cost of treatment for CAR-T therapy to be six times greater than for belamaf, but the QALYs gained from treatment are 6 to 8 times greater. Ide-cel was weakly dominated by cilta-cel and our base-case incremental cost effectiveness ratio (ICER) comparing cilta-cel with belamaf was $109,497 per QALY gained, averaging $123,618 in probabilistic sensitivity analyses. CONCLUSIONS These findings hinge on the assumption of longer-term survival but suggest that the use of CAR-T therapy is approaching standard ICER thresholds.
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Affiliation(s)
- Kandice A. Kapinos
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,RAND Corporation, Arlington, VA, USA,Kandice A. Kapinos, Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9096, USA.
| | - Ellen Hu
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jigar Trivedi
- Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas 75390-9096, TX, USA
| | - Praveen Ramakrishnan Geethakumari
- Division of Hematologic Malignancies and Cellular Therapy, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ankit Kansagra
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Division of Hematologic Malignancies and Cellular Therapy, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Derman BA, Kansagra A, Zonder J, Stefka AT, Grinblatt DL, Anderson LD, Gurbuxani S, Narula S, Rayani S, Major A, Kin A, Jiang K, Karrison T, Jasielec J, Jakubowiak AJ. Elotuzumab and Weekly Carfilzomib, Lenalidomide, and Dexamethasone in Patients With Newly Diagnosed Multiple Myeloma Without Transplant Intent: A Phase 2 Measurable Residual Disease-Adapted Study. JAMA Oncol 2022; 8:1278-1286. [PMID: 35862034 DOI: 10.1001/jamaoncol.2022.2424] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Treatment of newly diagnosed multiple myeloma (NDMM) with a quadruplet regimen consisting of a monoclonal antibody, proteasome inhibitor, immunomodulatory imide, and corticosteroid has been associated with improved progression-free survival (PFS) compared with triplet regimens. The optimal quadruplet combination, and whether this obviates the need for frontline autologous stem cell transplant (ASCT), remains unknown. We evaluated elotuzumab and weekly carfilzomib, lenalidomide, and dexamethasone (Elo-KRd) without ASCT in NDMM. Objective To investigate the efficacy of Elo-KRd using a measurable residual disease (MRD)-adapted design in NDMM regardless of ASCT eligibility. Design, Setting, and Participants This multicenter, single-arm, phase 2 study enrolled patients between July 2017 and February 2021. Median follow-up was 29 months. Interventions Twelve to 24 cycles of Elo-KRd; consecutive MRD-negative results at 10-6 by next-generation sequencing (NGS) after cycles 8 (C8) and 12 determined the duration of Elo-KRd. This was followed by Elo-Rd (no carfilzomib) maintenance therapy until disease progression. Main Outcomes and Measures The primary end point was the rate of stringent complete response (sCR) and/or MRD-negativity (10-5) after C8 Elo-KRd. Secondary end points included safety, rate of response, MRD status, PFS, and overall survival (OS). As an exploratory analysis, MRD was assessed using liquid chromatography mass spectrometry (MS) on peripheral blood samples. Results Forty-six patients were enrolled (median age 62 years, 11 [24%] aged >70 years). Overall, 32 (70%) were White, 6 (13%) were Black, 3 (6%) were more than 1 race, and 5 (11%) were of unknown race. Thirty-three (72%) were men and 13 (28%) were women. High-risk cytogenetic abnormalities were present in 22 (48%) patients. The rate of sCR and/or MRD-negativity after C8 was 26 of 45 (58%), meeting the predefined statistical threshold for efficacy. Responses deepened over time, with the MRD-negativity (10-5) rate increasing to 70% and MS-negativity rate increasing to 65%; concordance between MRD by NGS and MS increased over time. The most common (>10%) grade 3 or 4 adverse events were lung and nonpulmonary infections (13% and 11%, respectively). There was 1 grade 5 myocardial infarction. The estimated 3-year PFS was 72% overall and 92% for patients with MRD-negativity (10-5) at C8. Conclusions and Relevance An MRD-adapted design using elotuzumab and weekly KRd without ASCT showed a high rate of sCR and/or MRD-negativity and durable responses. This approach provides support for further evaluation of MRD-guided deescalation of therapy to decrease treatment exposure while sustaining deep responses. Trial Registration ClinicalTrials.gov Identifier: NCT02969837.
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Affiliation(s)
| | - Ankit Kansagra
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Jeffrey Zonder
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | | | - Larry D Anderson
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | | | - Sunil Narula
- University of Chicago Medical Center, Chicago, Illinois
| | - Shayan Rayani
- University of Chicago Medical Center, Chicago, Illinois
| | - Ajay Major
- University of Chicago Medical Center, Chicago, Illinois
| | - Andrew Kin
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Ken Jiang
- University of Chicago Medical Center, Chicago, Illinois
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7
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Dholaria B, Radujkovic A, Estrada‐Merly N, Sirait T, Kim S, Hernández‐Boluda JC, Czerw T, Hayden PJ, Kansagra A, Ho VT, Nishihori T, Shaughnessy P, Scott B, Nakamura R, Oran B, Kharfan‐Dabaja M, Savani BN, McLornan D, Yakoub‐Agha I, Saber W. Outcomes of allogeneic haematopoietic cell transplantation for chronic neutrophilic leukaemia: A combined
CIBMTR
/
CMWP
of
EBMT
analysis. Br J Haematol 2022; 198:785-789. [PMID: 35658101 PMCID: PMC9750039 DOI: 10.1111/bjh.18297] [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: 03/31/2022] [Revised: 05/14/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Noel Estrada‐Merly
- Center for International Blood and Marrow Transplant Research Medical College of Wisconsin Milwaukee Wisconsin USA
| | | | - Soyoung Kim
- Division of Biostatistics, Institute for Health and Equity Medical College of Wisconsin Milwaukee Wisconsin USA
| | | | - Tomasz Czerw
- Maria Skłodowska‐Curie National Research Institute of Oncology Gliwice Poland
| | - Patrick J. Hayden
- Department of Haematology Trinity College Dublin, St. James's Hospital Dublin Ireland
| | | | - Vincent T. Ho
- Dana‐Farber Cancer Institute Boston Massachusetts USA
| | | | - Paul Shaughnessy
- Sarah Cannon Transplant and Cellular Therapy Program Methodist Hospital San Antonio Texas USA
| | - Bart Scott
- Fred Hutchinson Cancer Research Center Seattle WA USA
| | | | - Betul Oran
- University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | - Bipin N. Savani
- Vanderbilt University Medical Center Nashville Tennessee USA
| | | | | | - Wael Saber
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research) Medical College of Wisconsin Milwaukee Wisconsin USA
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Dhakal B, Shah N, Kansagra A, Kumar A, Lonial S, Garfall A, Cowan A, Poudyal BS, Costello C, Gay F, Cook G, Quach H, Einsele H, Schriber J, Hou J, Costa L, Aljurf M, Chaudhry M, Beksac M, Prince M, Mohty M, Janakiram M, Callander N, Biran N, Malhotra P, Otero PR, Moreau P, Abonour R, Iftikhar R, Silberman R, Mailankody S, Gregory T, Lin Y, Carpenter P, Hamadani M, Usmani S, Kumar S. ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Multiple Myeloma. Transplant Cell Ther 2022; 28:284-293. [PMID: 35306217 DOI: 10.1016/j.jtct.2022.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Over the past decade, therapeutic options in multiple myeloma (MM) have changed dramatically. Given the unprecedented efficacy of novel agents, the role of hematopoietic cell transplantation (HCT) in MM remains under scrutiny. Rapid advances in myeloma immunotherapy including the recent approval of chimeric antigen receptor (CAR) T-cell therapy will impact the MM therapeutic landscape. The American Society for Transplantation and Cellular Therapy convened an expert panel to formulate clinical practice recommendations for role, timing, and sequencing of autologous (auto-HCT), allogeneic (allo-HCT) and CAR T-cell therapy for patients with newly diagnosed (NDMM) and relapsed/refractory MM (RRMM). The RAND-modified Delphi method was used to generate consensus statements. Twenty consensus statements were generated. The panel endorsed continued use of auto-HCT consolidation for patients with NDMM as a standard-of-care option, whereas in the front line allo-HCT and CAR-T were not recommended outside the setting of clinical trial. For patients not undergoing auto-HCT upfront, the panel recommended its use in first relapse. Lenalidomide as a single agent was recommended for maintenance especially for standard risk patients. In the RRMM setting, the panel recommended the use of CAR-T in patients with 4 or more prior lines of therapy. The panel encouraged allo-HCT in RRMM setting only in the context of clinical trial. The panel found RAND-modified Delphi methodology effective in providing a formal framework for developing consensus recommendations for the timing and sequence of cellular therapies for MM.
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Affiliation(s)
- Binod Dhakal
- Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nina Shah
- Division of Hematology-Oncology, University of California, San Francisco, California
| | - Ankit Kansagra
- Department of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ambuj Kumar
- Program for Comparative Effectiveness Research, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Alfred Garfall
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew Cowan
- University of Washington, Seattle WA, and Fred Hutch, Seattle, Washington
| | - Bishesh Sharma Poudyal
- Department of Clinical Hematology and Bone Marrow Transplant, Civil Service Hospital, Kathmandu, Nepal
| | - Caitlin Costello
- UCSD/Sharp Healthcare Transplant Program, Blood & Marrow Transplant Services, Moore's Cancer Center, San-Diego, California
| | - Francesca Gay
- Division of Hematology 1 Clinical Trial Unit, AOU CIttà della salute e della Scienza, University of Torino, Turin, Italy
| | - Gordon Cook
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trial Research, University of Leeds, Leeds, United Kingdom
| | - Hang Quach
- University of Melbourne, St. Vincent's Hospital, Melbourne, Australia
| | - Herman Einsele
- Universitätsklinikum Würzburg, Department of Internal Medicine II, Würzburg, Germany
| | - Jeff Schriber
- Cancer Treatment Centers of America, Phoenix, Arizona
| | - Jian Hou
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Luciano Costa
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Maria Chaudhry
- Department of hematology/Oncology, George Washington University and Cancer Center, Washington, District of Columbia
| | - Meral Beksac
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Miles Prince
- Epworth Healthcare and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - Murali Janakiram
- Division of Myeloma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, California
| | | | - Noa Biran
- Hackensack Meridian Health, John Theurer Cancer Center, Multiple Myeloma Division, Hackensack, New Jersey
| | - Pankaj Malhotra
- Department of Clinical Hematology & Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - Rafat Abonour
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Rebecca Silberman
- Department of Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New, York, New York
| | - Tara Gregory
- Colorado Blood Cancer Institute, Sarah Cannon Cancer Network, Denver, Colorado
| | - Yi Lin
- Mayo Clinic, Rochester, Minnesota
| | - Paul Carpenter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Pediatrics, University of Washington, Seattle, Washington
| | - Mehdi Hamadani
- Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Saad Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New, York, New York
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9
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Costa LJ, Lin Y, Cornell RF, Martin T, Chhabra S, Usmani SZ, Jagannath S, Callander NS, Berdeja JG, Kang Y, Vij R, Godby KN, Malek E, Neppalli A, Liedtke M, Fiala M, Tian H, Valluri S, Marino J, Jackson CC, Banerjee A, Kansagra A, Schecter JM, Kumar S, Hari P. Comparison of Cilta-cel, an Anti-BCMA CAR-T Cell Therapy, Versus Conventional Treatment in Patients With Relapsed/Refractory Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2022; 22:326-335. [PMID: 34840088 DOI: 10.1016/j.clml.2021.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the single-arm, phase 1b/2 CARTITUDE-1 study, ciltacabtagene autoleucel (cilta-cel), an anti-B-cell maturation antigen chimeric antigen receptor T-cell (CAR-T) therapy, showed encouraging efficacy in US patients with multiple myeloma (MM) who previously received an immunomodulatory drug, proteasome inhibitor, and anti-CD38 monoclonal antibody (triple-class exposed). PATIENTS AND METHODS A dataset of US patients refractory to an anti-CD38 monoclonal antibody (MAMMOTH) was used to identify patients who would meet eligibility for CARTITUDE-1 and received subsequent non-CAR-T therapy. The intent-to-treat (ITT) population in CARTITUDE-1 included patients who underwent apheresis (N = 113); the modified ITT (mITT) population was the subset who received cilta-cel (n = 97). Corresponding populations were identified from the MAMMOTH dataset: ITT population (n = 190) and mITT population of patients without progression/death within 47 days (median apheresis-to-cilta-cel infusion time) from onset of therapy (n = 122). Using 1:1 nearest neighbor propensity score matching to control for selected baseline covariates, 95 and 69 patients in CARTITUDE-1 ITT and mITT populations, respectively, were matched to MAMMOTH patients. RESULTS In ITT cohorts of CARTITUDE-1 vs. MAMMOTH, improved overall response rate (ORR; 84% vs. 28% [P < .001]) and longer progression-free survival (PFS; hazard ratio [HR], 0.11 [95% confidence interval (CI), 0.05-0.22]) and overall survival (OS; HR, 0.20 [95% CI, 0.10-0.39]) were observed. Similar results were seen in mITT cohorts of CARTITUDE-1 vs. MAMMOTH (ORR: 96% vs. 30% [P < .001]; PFS: HR, 0.02 [95% CI, 0.01-0.14]; OS: HR, 0.05 [95% CI, 0.01-0.22]) and with alternative matching methods. CONCLUSION Cilta-cel yielded significantly improved outcomes versus real-world therapies in triple-class exposed patients with relapsed/refractory MM.
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Affiliation(s)
- Luciano J Costa
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL.
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - R Frank Cornell
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas Martin
- Department of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Saurabh Chhabra
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Saad Z Usmani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute-Atrium Health, Charlotte, NC
| | - Sundar Jagannath
- Department of Medicine, Mount Sinai Medical Center, New York, NY
| | | | - Jesus G Berdeja
- Center for Blood Cancers, Sarah Cannon Research Institute, Nashville, TN
| | - Yubin Kang
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Ravi Vij
- Department of Medicine, Oncology Division, Washington University School of Medicine in St Louis, St Louis, MO
| | - Kelly N Godby
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Ehsan Malek
- Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Amarendra Neppalli
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Michaela Liedtke
- Department of Medicine, Division of Hematology, Stanford University, Stanford, CA
| | - Mark Fiala
- Department of Medicine, Oncology Division, Washington University School of Medicine in St Louis, St Louis, MO
| | - Hong Tian
- Clinical Development, Cellular Therapy Program, Janssen R&D, Raritan, NJ
| | | | - Jennifer Marino
- Clinical Research, Early Oncology Development, Janssen R&D, Spring House, PA
| | - Carolyn C Jackson
- Clinical Development, Cellular Therapy Program, Janssen R&D, Raritan, NJ
| | - Arnob Banerjee
- Clinical Research, Early Oncology Development, Janssen R&D, Spring House, PA
| | - Ankit Kansagra
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX
| | - Jordan M Schecter
- Clinical Development, Cellular Therapy Program, Janssen R&D, Raritan, NJ
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Parameswaran Hari
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
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10
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Wilden A, Sannareddy A, Patel H, Kansagra S, Kaur G, Ramakrishnan P, Patel P, Mehta A, Kansagra A. HSR22-178: Real World Outcomes of Cancer Patients With SARS-CoV-2 Infection Receiving Monoclonal Antibodies. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Hetal Patel
- 1 UT Southwestern Medical Center, Dallas, TX
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11
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Mohamedi A, Lin M, Mehta A, Kaur G, Anderson L, D'Souza A, Kansagra A. EPR22-115: Reporting of Race and Ethnicity in AL Amyloid Clinical Trials. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7270] [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: 11/17/2022]
Affiliation(s)
- Ali Mohamedi
- 1 The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Gurbakhash Kaur
- 1 The University of Texas Southwestern Medical Center, Dallas, TX
| | - Larry Anderson
- 1 The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Ankit Kansagra
- 1 The University of Texas Southwestern Medical Center, Dallas, TX
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12
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Murthy H, Zhang MJ, Chen K, Ganguly S, Ahmed S, Michelis FV, Nishihori T, Deotare U, Kansagra A, Patnaik MM, Litzow MR, Kebriaei P, Hourigan CS, Page K, Kharfan-Dabaja MA, Saber W. Outcomes of Allogeneic Hematopoietic Cell Transplantation in Blastic Plasmacytoid Dendritic Cell Neoplasm: A CIBMTR Analysis. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00310-4] [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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13
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Derman BA, Belli AJ, Battiwalla M, Hamadani M, Kansagra A, Lazarus HM, Wang CK. Reality check: Real-world evidence to support therapeutic development in hematologic malignancies. Blood Rev 2022; 53:100913. [DOI: 10.1016/j.blre.2021.100913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022]
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14
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Affiliation(s)
- Justin L Grodin
- Divisions of Cardiology (J.L.G.), Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Larry D Anderson
- Hematology and Oncology (L.D.A., A.K.), Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ankit Kansagra
- Hematology and Oncology (L.D.A., A.K.), Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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15
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Ahmed S, Zhao Q, Hanel W, Qazilbash MH, Patel K, Narra R, Kansagra A, Iqbal M, Awan FT, Christian B, Jaglowski SM, Kharfan-Dabaja MA, Hamadani M, Epperla N. Post-relapse survival in Waldenstrom macroglobulinemia patients experiencing therapy failure following autologous transplantation. Hematol Oncol 2021; 40:48-56. [PMID: 34763367 DOI: 10.1002/hon.2946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/15/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 11/05/2022]
Abstract
Waldenström macroglobulinemia (WM) is a rare B-cell lymphoproliferative malignancy. Autologous hematopoietic cell transplantation (auto-HCT) is considered in a subset of WM patients with relapsed disease. While registry data has shown a benefit for auto-HCT in relapsed WM, there is a paucity of data on outcomes of patients relapsing after auto-HCT. Eligibility criteria included adult patients with relapsed/refractory WM who underwent auto-HCT between 2007 and 2017. The primary endpoint was post-relapse overall survival (PR-OS). Secondary endpoints were to identify factors prognostic of PR-OS. Of the 48 patients with WM who underwent auto-HCT, 22 (46%) experienced relapse following auto-HCT. Median PR-OS of relapsed WM patients after auto-HCT (n = 22) was not reached (NR) (95% confidence interval [CI]: 17.5 months-NR). Among patients who relapsed <1 year versus ≥1 year from auto-HCT, the median PR-OS was 18.4 months (95%CI: 0.8-NR) months and NR (95%CI: 17.5-NR), respectively (p = 0.06). Of note, disease status at the time of transplant, CR/VGPR versus partial remission did not appear to impact PR-OS. The median PR-OS was significantly longer in patients who received ibrutinib in the post-transplant setting compared to those who did not (NR vs. 18.4 months, 95%CI: 9.1-NR, p = 0.02). On univariable analysis, the presence of complex karyotype (RR = 4.87, 95% CI = 1.22-19.53) and a higher number of prior lines of therapy (RR = 1.81, 95% CI = 1.23-2.67) were associated with a significantly higher risk of relapse. This is the only study to date that evaluated outcomes of WM patients who relapsed following auto-HCT and provides a benchmark for future trials evaluating survival following auto-HCT relapse.
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Affiliation(s)
- Sairah Ahmed
- Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas, USA.,Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Qiuhong Zhao
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Walter Hanel
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Krina Patel
- Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Ravi Narra
- Department of Medicine, BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ankit Kansagra
- Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madiha Iqbal
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Farrukh T Awan
- Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Beth Christian
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Samantha M Jaglowski
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Mehdi Hamadani
- Department of Medicine, BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Narendranath Epperla
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
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16
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Stadtmauer E, Karlin L, Weisel K, Gatt ME, Kansagra A, Monohan G, Yee A, Rockow-Magnone S, Cordero J, Hoffman D, Bueno O, Wu K, Gasparetto C. 448 Lemzoparlimab (TJ011133), an anti-CD47 antibody, with/without dexamethasone plus anti-myeloma regimens for relapsed/refractory multiple myeloma: a phase 1b dose escalation and expansion study. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundDespite therapeutic advancements for multiple myeloma (MM), most patients with MM develop relapsed/refractory (R/R) disease, which is associated with high mortality and highlights an unmet need for novel treatments.A key characteristic of MM cells is the overexpression of CD47, which downregulates phagocytosis, thereby allowing malignant plasma cells to evade destruction by the immune system. Blocking CD47 with lemzoparlimab, an anti-CD47 monoclonal antibody, may enhance macrophage-mediated anti-tumor activity.This study will characterize the safety, dose-limiting toxicity, and recommended dosing of lemzoparlimab (TJ011133) with or without dexamethasone and combined with other anti-myeloma regimens in patients with R/R MM.MethodsThis phase 1b, open-label, dose-escalation and expansion study (NCT04895410) will enroll adults with R/R MM, an Eastern Cooperative Oncology Group Performance Status ≤2, prior treatment history (varies based on treatment arm; Figure 1), and measurable disease (serum monoclonal paraprotein [M-protein] ≥0.5 g/dL, urine M-protein ≥200 mg/24 hours, or serum-free light chain ≥100 mg/L).Patients will be enrolled in 2 phases (escalation and expansion), divided into 4 arms to receive treatment in 28-day cycles (figure 1): (A) lemzoparlimab ± dexamethasone; (B) lemzoparlimab + dexamethasone + pomalidomide (4 mg orally daily [Days 1–21]); (C) lemzoparlimab + dexamethasone + carfilzomib (56 mg/m2 intravenously, 6 doses/cycle [first 2 doses in Cycle 1: 20 mg/m2]); and (D) lemzoparlimab + dexamethasone + daratumumab (1800 mg subcutaneously [Cycle 1, start on Day 2; Cycles 1–2, once weekly; Cycles 3–6, every 2 weeks; Cycles ≥7, Day 1]). Dexamethasone will be administered orally twice weekly at 20 mg for Arm C, and orally or intravenously weekly at 40 mg for other arms. Dose escalation will follow Bayesian optimal interval design. Once maximum tolerated dose/recommended phase 2 dose (RP2D) is determined, patients will be enrolled in the expansion. Treatment discontinuation criteria are: unacceptable toxicity, disease progression, consent withdrawal, or investigator’s discretion.The primary endpoint is determination of the RP2D. Secondary endpoints include safety and efficacy measures. Time-to-event endpoints will be analyzed using the Kaplan–Meier method.AcknowledgementsAbbVie is funding this study and participating in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship.Medical writing support was provided by Marta Rossi, PhD, of Fishawack Communications Ltd, and funded by AbbVie.Trial RegistrationClinicalTrials.gov: NCT04895410Ethics ApprovalThe protocol, informed consent form(s), recruitment materials, and all patient materials will be submitted to the Independent Ethics Committee/Institutional Review Board for review and approval.Abstract 448 Figure 1Study schematicThe dose escalation phase will follow BOIN; it will start with lemzoparlimab (TJ011133) monotherapy at DL1 in Arm A. If DL1 is not tolerated as monotherapy or as combination therapy, DL −1 will be evaluated. Investigation of combination arms will start after evaluation of monotherapy.Arms A, B, C and D will include patients with R/R MM after progressing on defined therapies and number of prior lines of therapy.BOIN, Bayesian optimal interval; DL, dose level; MM, multiple myeloma; R/R, relapsed/refractory.
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17
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Chen H, Chen Y, Deng M, John S, Gui X, Kansagra A, Chen W, Kim J, Lewis C, Wu G, Xie J, Zhang L, Huang R, Liu X, Arase H, Huang Y, Yu H, Luo W, Xia N, Zhang N, An Z, Zhang CC. Antagonistic anti-LILRB1 monoclonal antibody regulates antitumor functions of natural killer cells. J Immunother Cancer 2021; 8:jitc-2019-000515. [PMID: 32771992 PMCID: PMC7418854 DOI: 10.1136/jitc-2019-000515] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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] [Accepted: 07/01/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Current immune checkpoint blockade strategies have been successful in treating certain types of solid cancer. However, checkpoint blockade monotherapies have not been successful against most hematological malignancies including multiple myeloma and leukemia. There is an urgent need to identify new targets for development of cancer immunotherapy. LILRB1, an immunoreceptor tyrosine-based inhibitory motif-containing receptor, is widely expressed on human immune cells, including B cells, monocytes and macrophages, dendritic cells and subsets of natural killer (NK) cells and T cells. The ligands of LILRB1, such as major histocompatibility complex (MHC) class I molecules, activate LILRB1 and transduce a suppressive signal, which inhibits the immune responses. However, it is not clear whether LILRB1 blockade can be effectively used for cancer treatment. METHODS First, we measured the LILRB1 expression on NK cells from cancer patients to determine whether LILRB1 upregulated on NK cells from patients with cancer, compared with NK cells from healthy donors. Then, we developed specific antagonistic anti-LILRB1 monoclonal antibodies and studied the effects of LILRB1 blockade on the antitumor immune function of NK cells, especially in multiple myeloma models, in vitro and in vivo xenograft model using non-obese diabetic (NOD)-SCID interleukin-2Rγ-null mice. RESULTS We demonstrate that percentage of LILRB1+ NK cells is significantly higher in patients with persistent multiple myeloma after treatment than that in healthy donors. Further, the percentage of LILRB1+ NK cells is also significantly higher in patients with late-stage prostate cancer than that in healthy donors. Significantly, we showed that LILRB1 blockade by our antagonistic LILRB1 antibody increased the tumoricidal activity of NK cells against several types of cancer cells, including multiple myeloma, leukemia, lymphoma and solid tumors, in vitro and in vivo. CONCLUSIONS Our results indicate that blocking LILRB1 signaling on immune effector cells such as NK cells may represent a novel strategy for the development of anticancer immunotherapy.
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Affiliation(s)
- Heyu Chen
- Department of Physiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Yuanzhi Chen
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA.,School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Mi Deng
- Department of Physiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Samuel John
- Department of Pediatrics, Pediatric Hematology- Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Xun Gui
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ankit Kansagra
- Department of Hematology and Oncology, UT Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Weina Chen
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jaehyup Kim
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Cheryl Lewis
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Guojin Wu
- Department of Physiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jingjing Xie
- Department of Physiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Lingbo Zhang
- Department of Physiology, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ryan Huang
- Department of Physiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Xiaoye Liu
- Department of Physiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hisashi Arase
- Department of Immunochemistry, Research Institute for Microbial Diseases and Laboratory of Immunochemistry, World Premier International Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Yang Huang
- School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Hai Yu
- School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Wenxin Luo
- School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ningshao Xia
- School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ningyan Zhang
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Zhiqiang An
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Cheng Cheng Zhang
- Department of Physiology, UT Southwestern Medical Center, Dallas, Texas, USA
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18
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Percival ME, Wang HL, Zhang MJ, Saber W, de Lima M, Litzow M, Kebriaei P, Abdel-Azim H, Adekola K, Aljurf M, Bacher U, Badawy SM, Beitinjaneh A, Bejanyan N, Bhatt V, Byrne M, Cahn JY, Castillo P, Chao N, Chhabra S, Copelan E, Cutler C, DeFilipp Z, Dias A, Diaz MA, Estey E, Farhadfar N, Frangoul HA, Freytes CO, Gale RP, Ganguly S, Gowda L, Grunwald M, Hossain N, Kamble RT, Kanakry CG, Kansagra A, Kharfan-Dabaja MA, Krem M, Lazarus HM, Lee JW, Liesveld JL, Lin R, Liu H, McGuirk J, Munker R, Murthy HS, Nathan S, Nishihori T, Olsson RF, Palmisiano N, Passweg JR, Prestidge T, Ringdén O, Rizzieri DA, Rybka WB, Savoie ML, Schultz KR, Seo S, Sharma A, Solh M, Strair R, van der Poel M, Verdonck LF, Yared JA, Weisdorf D, Sandmaier BM. Impact of depth of clinical response on outcomes of acute myeloid leukemia patients in first complete remission who undergo allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2021; 56:2108-2117. [PMID: 33864019 PMCID: PMC8425595 DOI: 10.1038/s41409-021-01261-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/31/2020] [Revised: 02/03/2021] [Accepted: 02/23/2021] [Indexed: 02/05/2023]
Abstract
Acute myeloid leukemia (AML) patients often undergo allogeneic hematopoietic cell transplantation (alloHCT) in first complete remission (CR). We examined the effect of depth of clinical response, including incomplete count recovery (CRi) and/or measurable residual disease (MRD), in patients from the Center for International Blood and Marrow Transplantation Research (CIBMTR) registry. We identified 2492 adult patients (1799 CR and 693 CRi) who underwent alloHCT between January 1, 2007 and December 31, 2015. The primary outcome was overall survival (OS). Multivariable analysis was performed to adjust for patient-, disease-, and transplant-related factors. Baseline characteristics were similar. Patients in CRi compared to those in CR had an increased likelihood of death (HR: 1.27; 95% confidence interval: 1.13-1.43). Compared to CR, CRi was significantly associated with increased non-relapse mortality (NRM), shorter disease-free survival (DFS), and a trend toward increased relapse. Detectable MRD was associated with shorter OS, shorter DFS, higher NRM, and increased relapse compared to absence of MRD. The deleterious effects of CRi and MRD were independent. In this large CIBMTR cohort, survival outcomes differ among AML patients based on depth of CR and presence of MRD at the time of alloHCT. Further studies should focus on optimizing post-alloHCT outcomes for patients with responses less than CR.
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Affiliation(s)
- Mary-Elizabeth Percival
- Division of Hematology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Hai-Lin Wang
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mei-Jie Zhang
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wael Saber
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kehinde Adekola
- Division of Hematology and Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Vijaya Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Paul Castillo
- UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Nelson Chao
- Department of Medicine, Division of Cell Therapy and Hematology, Duke University Medical Center, Durham, NC, USA
| | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Corey Cutler
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Westwood, KS, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Elihu Estey
- Division of Hematology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nosha Farhadfar
- Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Haydar A Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | | | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | | | - Michael Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nasheed Hossain
- Department of Medicine, Division of Hematology and Oncology, Stem Cell Transplant Program-Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Rammurti T Kamble
- Center for Cell and Gene Therapy, Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Christopher G Kanakry
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ankit Kansagra
- UT Southwestern Medical Center-BMT Program, Dallas, TX, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Maxwell Krem
- University of Louisville Hospital/James Brown Cancer Center, Louisville, KY, USA
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jong Wook Lee
- Division of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jane L Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Richard Lin
- Memorial Sloan Kettering Cancer Center-Adults, New York, NY, USA
| | - Hongtao Liu
- University of Chicago Medicine, Chicago, IL, USA
| | | | - Reinhold Munker
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | | | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Neil Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Olov Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm, Sweden
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | | | | | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Roger Strair
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | | | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Department of Medicine, Division of Hematology and Oncology, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Daniel Weisdorf
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Geethakumari PR, Ramasamy DP, Dholaria B, Berdeja J, Kansagra A. Balancing Quality, Cost, and Access During Delivery of Newer Cellular and Immunotherapy Treatments. Curr Hematol Malig Rep 2021; 16:345-356. [PMID: 34089485 PMCID: PMC8179081 DOI: 10.1007/s11899-021-00635-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The chimeric antigen receptor (CAR) T-cell therapy is currently changing the landscape of hematologic malignancies with multiple FDA-approved cell therapy products in the USA. The current administration process of the CAR T-cell therapy is complicated, labor-intensive, and expensive. RECENT FINDINGS The chimeric antigen receptor (CAR) T-cell therapy is currently changing the landscape of hematologic malignancies with multiple FDA-approved cell therapy products in the USA. The current administration process of the CAR T-cell therapy is complicated, labor-intensive, and expensive. This review article addresses the present-day challenges and discusses opportunities to optimize the access and affordability of the CAR T-cell therapy. The field of cellular immunotherapy is going to change the future of solid tumors and non-oncological diseases. However, this promising therapy poses challenges in the administration and management of quality in the current field of healthcare. We describe various novel approaches to manage challenges in improving access and improving widescale implementation of cellular therapies.
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Affiliation(s)
| | - Dheepthi Perumal Ramasamy
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX, 76034, USA
| | | | - Jesús Berdeja
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN, USA
| | - Ankit Kansagra
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX, 76034, USA.
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20
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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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21
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Costa LJ, Lin Y, Martin TG, Chhabra S, Usmani SZ, Jagannath S, Callander NS, Berdeja JG, Kang Y, Vij R, Tian H, Valluri S, Marino J, Jackson CC, Banerjee A, Kansagra A, Schecter JM, Kumar S, Hari P. Cilta-cel versus conventional treatment in patients with relapse/refractory multiple myeloma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8030] [Citation(s) in RCA: 6] [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: 11/20/2022] Open
Abstract
8030 Background: CARTITUDE-1 is a single arm study of Ciltacabtagene autoleucel (cilta-cel; JNJ-68284528) anti-BCMA CAR-T cell therapy in US patients (pts) with relapsed multiple myeloma (RRMM) refractory to both IMiD and proteasome inhibitor (PI) or with at least 3 prior lines of therapy and previously exposed to anti-CD38 monoclonal antibody (MoAb). While recently reported efficacy results of cilta-cel were encouraging, it is unknown how they compare with similar pts receiving conventional (non CAR-T) treatment. Methods: We utilized a contemporary US-based dataset of pts with MM refractory to anti-CD38 MoAb (MAMMOTH) to identify pts who would meet eligibility for CARTITUDE-1 and who received conventional therapy. We analyzed the intent-to-treat population (ITT) in CARTITUDE-1, defined as pts who underwent apheresis (N=113) and a modified ITT population (mITT) defined as subset of pts who received cilta-cel at the RP2D (N=97). From the MAMMOTH dataset, we identified a population corresponding to CARTITUDE-1 ITT (N=190) and a mITT population, pts without death or progression within 47 days (median time between apheresis and cilta-cel infusion) from onset of therapy (N=122). We calculated propensity scores (PS) with demographics, N of prior therapies, cytogenetics and refractoriness to MM agents as covariates. An analyst blinded to outcomes performed nearest neighbor 1:1 PS matching. We analyzed overall response rate (ORR), progression-free (PFS) and overall survival (OS) for ITT and mITT in CARTITUDE-1 vs matching MAMMOTH cohorts. Results: Ninety-five ITT (75 received bridging therapy, 82 received cilta-cel) and 69 mITT (54 received bridging) CARTITUDE-1 pts matched MAMMOTH pts (Table). Among the pts in the MAMMOTH ITT cohort 34% received pomalidomide, 24% anti-CD38 MoAb, 19% carfilzomib and 35% cytotoxic chemotherapy in next therapy. ORR in the ITT cohorts was higher in CARTITUDE-1 (84% vs. 28%). Compared to their MAMMOTH counterparts, pts in CARTITUDE-1 ITT cohort had improved PFS (12 mo. 73% vs. 12%) and OS (12 mo. 83% vs 39%). Between the mITT cohorts, CARTITUDE-1 pts had superior ORR (96% vs. 30%), PFS (12 mo 79% vs. 15%) and OS (12 mo. 88% vs. 41%). Conclusions: In pts with RRMM beyond therapy with IMID, PI, and anti-CD38 MoAb, treatment with cilta-cel is associated with higher response rate and superior PFS and OS when compared to conventional treatment.[Table: see text]
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Affiliation(s)
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Thomas G. Martin
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | | | | | | | - Jesus G. Berdeja
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
| | | | - Ravi Vij
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | | | - Ankit Kansagra
- University of Texas Southwestern Medical School, Dallas, TX
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22
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Percival ME, Wang HL, Zhang MJ, Saber W, de Lima M, Litzow M, Kebriaei P, Abdel-Azim H, Adekola K, Aljurf M, Bacher U, Badawy SM, Beitinjaneh A, Bejanyan N, Bhatt V, Byrne M, Cahn JY, Castillo P, Chao N, Chhabra S, Copelan E, Cutler C, DeFilipp Z, Dias A, Diaz MA, Estey E, Farhadfar N, Frangoul HA, Freytes CO, Gale RP, Ganguly S, Gowda L, Grunwald M, Hossain N, Kamble RT, Kanakry CG, Kansagra A, Kharfan-Dabaja MA, Krem M, Lazarus HM, Lee JW, Liesveld JL, Lin R, Liu H, McGuirk J, Munker R, Murthy HS, Nathan S, Nishihori T, Olsson RF, Palmisiano N, Passweg JR, Prestidge T, Ringdén O, Rizzieri DA, Rybka WB, Savoie ML, Schultz KR, Seo S, Sharma A, Solh M, Strair R, van der Poel M, Verdonck LF, Yared JA, Weisdorf D, Sandmaier BM. Correction to: Impact of depth of clinical response on outcomes of acute myeloid leukemia patients in first complete remission who undergo allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2021; 56:2319. [PMID: 34017072 DOI: 10.1038/s41409-021-01353-3] [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: 11/09/2022]
Affiliation(s)
- Mary-Elizabeth Percival
- Division of Hematology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Hai-Lin Wang
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mei-Jie Zhang
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wael Saber
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kehinde Adekola
- Division of Hematology and Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Vijaya Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Paul Castillo
- UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Nelson Chao
- Department of Medicine, Division of Cell Therapy and Hematology, Duke University Medical Center, Durham, NC, USA
| | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Corey Cutler
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Westwood, KS, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Elihu Estey
- Division of Hematology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nosha Farhadfar
- Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Haydar A Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | | | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | | | - Michael Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nasheed Hossain
- Department of Medicine, Division of Hematology and Oncology, Stem Cell Transplant Program-Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Rammurti T Kamble
- Center for Cell and Gene Therapy, Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Christopher G Kanakry
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ankit Kansagra
- UT Southwestern Medical Center-BMT Program, Dallas, TX, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Maxwell Krem
- University of Louisville Hospital/James Brown Cancer Center, Louisville, KY, USA
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jong Wook Lee
- Division of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jane L Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Richard Lin
- Memorial Sloan Kettering Cancer Center-Adults, New York, NY, USA
| | - Hongtao Liu
- University of Chicago Medicine, Chicago, IL, USA
| | | | - Reinhold Munker
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | | | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Neil Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Olov Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm, Sweden
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | | | | | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Roger Strair
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | | | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Department of Medicine, Division of Hematology and Oncology, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Daniel Weisdorf
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA.,CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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23
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Kansagra A, Lin Y, Berdeja JG, Shah N, Oriol A, Yakoub-Agha I, Einsele H, Rambaldi A, Truppel-Hartmann A, Rowe E, Wang J, Agarwal A, Campbell TB, Lonial S. Characterization of Cytokine Release Syndrome (CRS) in the KarMMa Study of Idecabtagene Vicleucel (ide-cel, bb2121) for Relapsed and Refractory Multiple Myeloma (RRMM). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00511-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Madanat YF, Patel P, Chung S, Yan J, Ahn C, Khatib J, Tadic-Ovcina M, AhmedRabie A, Helton D, Shahan J, Dryden C, White A, Patel H, Ramakrishnan P, Kansagra A, Collins RH, Vusirikala M. Post-Transplant Cyclophosphamide and Early Mixed Donor Chimerism in Myeloid Malignancies; UT Southwestern Experience. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00177-9] [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: 11/24/2022]
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25
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Shahan JL, AhmedRabie A, Tadic-Ovcina M, Patel P, Ramakrishnan P, Kansagra A, Chung S, Collins RH, Madanat YF, Dryden C, Vusirikala M. Cytomegalovirus Reactivation in Allogeneic Hematopoietic Cell Transplant Recipients Receiving Letermovir Prophylaxis and Cytomegalovirus Specific T Cell Immunity, a Retrospective Single Center Experience. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00128-7] [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: 11/15/2022]
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26
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Lutfi F, Kansagra A, Ali MM, Bukhari A, Siglin J, Yan J, Samanta S, Holtzman NG, Gottlieb D, Kim D, Lee ST, Kocoglu MH, Yared JA, Hardy NM, Molitoris J, Mohindra P, Rapoport AP, Dahiya S. The Impact of Bridging Therapy Prior to CAR-T Cell Therapy on Clinical Outcomes of Patients with Relapsed Refractory Large B-Cell Lymphoma. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00242-6] [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: 10/22/2022]
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27
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Belli AJ, Hansen E, Kansagra A, Dilwali K, Wang CK. Real-World Treatment Patterns and Outcomes of Patients with Functional High-Risk (Early Relapse) Multiple Myeloma. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00138-x] [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: 11/29/2022]
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28
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Stephens E, Mehta A, Persoon T, Baker S, David R, Nair K, Madanat YF, Rizvi S, Patel P, Chung S, Vusirkala M, Awan F, Anderson LD, Sweetenham JW, Collins RH, Ramakrishnan P, Ramasamy D, Kansagra A. Continuous Telemetry Monitoring in Chimeric Antigen Receptor (CAR) T-Cell Therapy Patients. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00260-8] [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: 11/24/2022]
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29
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Cornell R, Hari P, Tang S, Biran N, Callander N, Chari A, Chhabra S, Fiala MA, Gahvari Z, Gandhi U, Godby K, Gupta R, Jagannath S, Jagosky M, Kang Y, Kansagra A, Kauffman M, Kodali S, Kumar SK, Lakshman A, Liedtke M, Lonial S, Ma X, Malek E, Mansour J, McGehee EF, Neppalli A, Paul B, Richardson P, Scott EC, Shacham S, Shah J, Siegel DS, Umyarova E, Usmani SZ, Varnado W, Vij R, Costa L. Overall survival of patients with triple-class refractory multiple myeloma treated with selinexor plus dexamethasone vs standard of care in MAMMOTH. Am J Hematol 2021; 96:E5-E8. [PMID: 32974944 DOI: 10.1002/ajh.26010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Robert Cornell
- Vanderbilt University Medical Center Nashville, Tennessee
| | | | - Shijie Tang
- Karyopharm Therapeutics Inc Newton, Massachusetts
| | - Noa Biran
- John Theurer Cancer Center Hackensack University Hackensack, New Jersey
| | | | - Ajai Chari
- Mount Sinai School of Medicine New York, New York
| | | | - Mark A. Fiala
- Washington University School of Medicine St. Louis, Missouri
| | | | | | - Kelly Godby
- University of Alabama at Birmingham Birmingham, Alabama
| | - Ridhi Gupta
- Stanford University School of Medicine Stanford, California
| | | | - Megan Jagosky
- Levine Cancer Institute/Atrium Health Charlotte, North Carolina
| | - Yubin Kang
- Duke University School of Medicine Durham, North Carolina
| | - Ankit Kansagra
- University of Texas Southwestern Medical Center Dallas, Texas
| | | | - Saranya Kodali
- University of Vermont, College of Medicine Burlington, Vermont
| | | | - Arjun Lakshman
- Department of Internal Medicine University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | | | | | - Xiwen Ma
- Karyopharm Therapeutics Inc Newton, Massachusetts
| | - Ehsan Malek
- Case Western Reserve University Cleveland, Ohio
| | - Joshua Mansour
- City of Hope Comprehensive Center Duarte, California
- Kaiser Permanente Medical Group Los Angeles, California
| | | | | | - Barry Paul
- Levine Cancer Institute/Atrium Health Charlotte, North Carolina
| | - Paul Richardson
- Medical Oncology, Dana‐Farber Cancer Institute Harvard Medical School Boston, Massachusetts
| | | | | | - Jatin Shah
- Karyopharm Therapeutics Inc Newton, Massachusetts
| | - David S. Siegel
- John Theurer Cancer Center Hackensack University Medical Center Hackensack, New Jersey
| | - Elvira Umyarova
- University of Vermont, College of Medicine Burlington, Vermont
| | - Saad Z. Usmani
- Levine Cancer Institute/Atrium Health Charlotte, North Carolina
| | | | - Ravi Vij
- Washington University School of Medicine St. Louis, Missouri
| | - Luciano Costa
- University of Alabama at Birmingham Birmingham, Alabama
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30
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Mahimainathan L, Narasimhan M, Corchado R, Patel H, Kansagra A, Devaraj S, Geethakumari PR, Muthukumar A. Evaluation of SARS-CoV-2 Serological Testing in Patients with Multiple Myeloma and Other Hematologic Malignancies on Monoclonal Antibody Therapies. Diagnostics (Basel) 2020; 10:diagnostics10120992. [PMID: 33255154 PMCID: PMC7760559 DOI: 10.3390/diagnostics10120992] [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: 11/04/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Patients with hematological malignancies (HM), including multiple myeloma (MM), frequently suffer from immune deficiency-associated infectious complications because of both the disease and the treatment. Alarming results from China and the UK confirm the vulnerability of HM patients to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-driven coronavirus disease 2019 (COVID-19). Given that the immunoassay interference from the endogenous monoclonal immunoglobulin (M paraprotein) and treatment antibodies continually challenges the MM management, it is critical to evaluate the SARS-CoV-2 serology tests for suspected interference/cross-reactivity. Methods: We compared the degree of interference in three SARS-CoV-2 serology assay platforms in HM patients with and without COVID-19 and on various therapeutic monoclonal antibody (t-mAb) treatments. Further, we confirmed the cross-reactivity in pooled samples from normal and COVID-19 + samples spiked with respective antibodies in vitro. Results: None of the 93 HM patient samples with or without t-MAbs showed cross-reactivity on any of the three serology platforms tested. Conclusions: The tested three serologic assays for SARS-CoV-2 are specific and do not have cross-reactivity with M-components or t-MAbs indicating that they can be used safely in oncology practice and in research exploring the immunologic response to COVID-19 in patients with HM.
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Affiliation(s)
- Lenin Mahimainathan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (M.N.)
| | - Madhusudhanan Narasimhan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (M.N.)
| | - Rolando Corchado
- William P. Clements Jr. University Hospital (CUH), University of Texas Southwestern Medical Center, Dallas, TX 75235, USA;
| | - Hetalkumari Patel
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Ankit Kansagra
- Department of Internal Medicine, Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Sridevi Devaraj
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: (S.D.); (P.R.G.); (A.M.); Tel.: +1-832-826-1717 (S.D.); +1-214-648-2003 (P.R.G.); +1-214-645-5103 (A.M.)
| | - Praveen Ramakrishnan Geethakumari
- Division of Hematologic Malignancies and Stem Cell Transplantation, Harold. C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Correspondence: (S.D.); (P.R.G.); (A.M.); Tel.: +1-832-826-1717 (S.D.); +1-214-648-2003 (P.R.G.); +1-214-645-5103 (A.M.)
| | - Alagarraju Muthukumar
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (M.N.)
- Correspondence: (S.D.); (P.R.G.); (A.M.); Tel.: +1-832-826-1717 (S.D.); +1-214-648-2003 (P.R.G.); +1-214-645-5103 (A.M.)
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31
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Bergstrom CP, Dahiya S, Chen W, Zhang CC, Zhu H, Yan J, Madanat Y, Patel P, Vusirkala M, Ramakrishnan P, Rizvi S, Chung S, Awan F, Anderson LD, Collins R, Kansagra A. The association of leukocyte immunoglobulin-like receptor subfamily B-4 expression in acute myeloid leukemia and central nervous system involvement. Leuk Res 2020; 100:106480. [PMID: 33285315 DOI: 10.1016/j.leukres.2020.106480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
Central nervous system (CNS) involvement in patients with acute myeloid leukemia (AML) varies, ranging from 0.6%-46%. Leukocyte immunoglobulin-like receptor B4 (LILRB4) has been shown to be critical in orchestration of infiltration of AML cells into the CNS in animal models, however it is unknown if an association exists between LILRB4 and CNS involvement (CNS+) in human patients with AML. LILRB4 was measured by flow cytometry in a heterogeneous population of fifty-six AML patients. Patients were then followed clinically for the development of CNS + . LILRB4 was positive in 91 % of patients with CNS + compared to 38 % without CNS involvement (p < 0.002). In logistic analysis: age, BMI, serum albumin and positive LILRB4 were predictive for CNS+ [OR, 95 % CI, p-value]: 0.95, 0.92-0.99, p < 0.01; 0.85, 0.73-0.998, p < 0.05; 0.23, 0.066-0.78, p < 0.02; 16.46, 1.93-140.2, p < 0.02, respectively. This finding of the association of LILRB4 with CNS + in combination with earlier findings suggests that LILRB4 has a mechanistic role in infiltration of the CNS and may provide insight into the pathogenesis of AML seeding the CNS. Moreover, this proof of concept and the findings in the present study may lead to the development of innovative and novel therapies to improve the lives of patients with AML.
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Affiliation(s)
- Colin P Bergstrom
- Department of Medicine, UT Southwestern Medical Center, Dallas, USA.
| | - Saurabh Dahiya
- Department of Medicine, Department of Hematology and Oncology, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Weina Chen
- Department of Pathology, Department of Medicine, UT Southwestern Medical Center, Dallas, USA
| | - Cheng Cheng Zhang
- Department of Physiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Hong Zhu
- Department of Population and Data Science, Simmons Comprehensive Cancer Center, Dallas, USA
| | - Jingsheng Yan
- Department of Population and Data Science, Simmons Comprehensive Cancer Center, Dallas, USA
| | - Yazan Madanat
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Prapti Patel
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Madhuri Vusirkala
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Praveen Ramakrishnan
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Syed Rizvi
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Stephen Chung
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Farrukh Awan
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Larry D Anderson
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Robert Collins
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
| | - Ankit Kansagra
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, USA
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32
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Dhakal B, D'Souza A, Callander N, Chhabra S, Fraser R, Davila O, Anderson K, Assal A, Badawy SM, Berdeja J, Cerny J, Comenzo R, Chakraborty R, Peter Gale R, Kamble R, Kharfan-Dabaja MA, Krem M, Ganguly S, Janakiram M, Kansagra A, Munker R, Murthy H, Patel S, Kumar S, Shah N, Qazilbash M, Hari P. Novel prognostic scoring system for autologous hematopoietic cell transplantation in multiple myeloma. Br J Haematol 2020; 191:442-452. [PMID: 33094839 DOI: 10.1111/bjh.16987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/27/2020] [Accepted: 06/11/2020] [Indexed: 11/28/2022]
Abstract
We studied 2,528 patients with upfront autologous haematopoietic cell transplantation (AHCT) for multiple myeloma (MM) from 2008-2017 to develop a prognostic model to predict outcomes. High-risk cytogenetics included t(4;14), t(14;16), t(14;20), del13q on karyotype, del17p, +1q or 1pdel. A Cox model identified factors prognostic of progression/relapse in a training subset (n = 1,246). A weighted score using these factors was assigned to a validation cohort (n = 774). Presence of high-risk cytogenetics [hazard ratio, (HR) 1·68 (1·3-2·17)] and pre-AHCT bone marrow plasma cells (BMPCs) ≥10% [1·68 (1·33-2·12)] were assigned 4 points each; albumin at diagnosis <3·5 g/dl [1·31 (1·07-1·61)] 2; standard risk cytogenetics 1, and no cytogenetics abnormality, BMPCs <10% at AHCT and albumin ≥3·5 g/dl at diagnosis 0 points each. A three-category system with low risk (0-3), intermediate risk (4-8) and high risk (9-10) showed 3-year progression-free survival in the low vs. intermediate vs. high risk of 58% (95% CI: 52-63) vs. 49% (95% CI: 43-56) vs. 31% (95% CI: 12-51), P < 0.001 respectively, and 3-year OS in low vs. intermediate vs. high risk of 88% (95% CI: 84-91) vs. 81% (95% CI: 76-86) vs. 64% (95% CI: 39-80); P < 0·001. Our prognostic scoring system can identify MM patients at risk for early relapse after AHCT.
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Affiliation(s)
- Binod Dhakal
- BMT and Cellular Therapy, Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anita D'Souza
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Raphael Fraser
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omar Davila
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Amer Assal
- Department of Medicine, Bone Marrow Transplant and Cell Therapy Program, Columbia University Irving Medical Center, New York, NY, USA
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | | | | | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rammurti Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Maxwell Krem
- University of Louisville Hospital/James Brown Cancer Center, Louisville, KY, USA
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | | | - Ankit Kansagra
- UT Southwestern Medical Center - BMT Program, Dallas, TX, USA
| | - Reinhold Munker
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Hemant Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Sagar Patel
- Blood and Marrow Transplant Program, University of Utah, Salt Lake City, UT, USA
| | - Shaji Kumar
- Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nina Shah
- Division of Hematology-Oncology, University of California San Francisco, San Francisco, CA, USA
| | | | - Parameswaran Hari
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Ajufo E, Kansagra A, Torrealba J, Grodin JL. Uncommon Disease in a Rare Location: The Mystery of the Rapidly Progressive Cardiomyopathy. Circulation 2020; 142:1591-1595. [PMID: 33074757 DOI: 10.1161/circulationaha.120.048323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ezimamaka Ajufo
- Department of Internal Medicine (E.A.), University of Texas Southwestern Medical Center, Dallas
| | - Ankit Kansagra
- Division of Hematology and Oncology (A.K.), University of Texas Southwestern Medical Center, Dallas
| | - Jose Torrealba
- Department of Pathology (J.T.), University of Texas Southwestern Medical Center, Dallas
| | - Justin L Grodin
- Division of Cardiology (J.L.G.), University of Texas Southwestern Medical Center, Dallas
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Churchill HRO, Fuda FS, Xu J, Deng M, Zhang CC, An Z, Zhang N, Chen P, Bergstrom C, Kansagra A, Collins R, John S, Koduru P, Chen W. Leukocyte immunoglobulin-like receptor B1 and B4 (LILRB1 and LILRB4): Highly sensitive and specific markers of acute myeloid leukemia with monocytic differentiation. Cytometry B Clin Cytom 2020; 100:476-487. [PMID: 32918786 DOI: 10.1002/cyto.b.21952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/13/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) with monocytic differentiation (M-AML) remains a diagnostic challenge largely due to lack of sensitive and specific markers for immature monocytes. The immunoglobulin-like inhibitory receptors, LILRB1 and LILRB4, are expressed on monocytes but have not yet been systematically evaluated in the clinical setting. METHODS We evaluated the diagnostic performance of LILRB1 and LILRB4 as monocytic markers for both immature and mature monocytes in comparison to other myelomonocytic markers including CD14, CD15, CD33, CD36, and CD64 in eight cases of control bone marrow (BM, 5) and peripheral blood (PB, 3), 64 cases of (M-AML), and 57 cases of AML without monocytic differentiation (NM-AML) by flow cytometric immunophenotyping. RESULTS In control BM, LILRB1 and LILRB4 were consistently expressed on monocytes at all stages of maturation, from CD34+ /CD14- monocytic precursors to CD14-/dim+ maturing and CD14+ mature monocytes. In M-AML, LILRB1 and LILRB4 were consistently expressed on monocytes, regardless of the degree of maturity, from CD14-/dim+ monoblasts/promonocytes to CD14+ mature monocytes but were not expressed on myeloblasts. The diagnostic performances as a monocytic marker assessed by sensitivity/specificity were 100%/100% for LILRB1/LILRB4, 100%/82% for CD11b, 80%/100% for CD14, 100%/81% for CD64, 100%/58% for CD15/CD33, and 89%/97% for CD36/CD64. CONCLUSION The co-expression of LILRB1/LILRB4 outperformed other myelomonocytic markers as a highly sensitive and specific marker for monocytes at all stages of maturation and could reliably distinguish M-AML from NM-AML. LILRB4 additionally represents a novel therapeutic target for treating M-AML.
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Affiliation(s)
- Hywyn R O Churchill
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Franklin S Fuda
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jing Xu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mi Deng
- Department of Physiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cheng Cheng Zhang
- Department of Physiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zhiqiang An
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Ningyan Zhang
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Pu Chen
- Department of Laboratory Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Colin Bergstrom
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ankit Kansagra
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert Collins
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samuel John
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Prasad Koduru
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Mehta A, Fillmore N, Dahiya S, D'Souza A, Sweetenham J, Kansagra A. Reporting of race and ethnicity at an international haematology conference. Br J Haematol 2020; 191:e107-e109. [DOI: 10.1111/bjh.17065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ansh Mehta
- Department of Internal Medicine University of South Alabama Mobile AL USA
| | - Nathanael Fillmore
- VA Boston Healthcare System Boston MA USA
- Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
- Dana‐Farber Cancer Institute Boston MA USA
| | - Saurabh Dahiya
- Division of Hematology/Oncology University of Maryland Maryland MD USA
| | - Anita D'Souza
- Center for International Blood and Bone Marrow Transplant Research Milwaukee WI USA
- Department of Medicine Medical College of Wisconsin Milwaukee WI USA
| | - John Sweetenham
- Division of Hematology/Oncology UT Southwestern Medical Center Dallas TX USA
- Simmons Comprehensive Cancer CenterUT Southwestern Medical Center Dallas TX USA
| | - Ankit Kansagra
- Division of Hematology/Oncology UT Southwestern Medical Center Dallas TX USA
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Naddaf E, Milone M, Kansagra A, Buadi F, Kourelis T. Author response: Sporadic late-onset nemaline myopathy: Clinical spectrum, survival, and treatment outcomes. Neurology 2020; 94:1110-1111. [DOI: 10.1212/wnl.0000000000009659] [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: 11/15/2022] Open
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Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a major advancement in the treatment of lymphoid malignancies, especially diffuse large B-cell lymphoma and acute lymphoblastic leukemia (ALL). Since the U.S. Food and Drug Administration (FDA) approval of two CAR T-cell therapies, axicabtagene ciloleucel and tisagenlecleucel, experience has highlighted various barriers to their broader access and use, including challenges related to manufacturing a patient-specific product, high costs and inadequate reimbursement, incomplete or nonsustained disease responses, and potential for causing life-threatening toxicities. Research on disparities, application, and practice of hematopoietic cell transplantation (HCT) can inform opportunities to address similar barriers to use of CAR T-cell therapies that are currently available as well as other cellular therapies that are expected to become available in the near future. To ensure optimal patient outcomes, these therapies should preferably be administered at centers that have experience and established quality processes and practices. We review opportunities for centers, manufacturers, payers, and policy makers to address barriers to care. We also provide a summary of available and alternative payments models for commercial CAR T-cell and other cellular therapies.
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Affiliation(s)
- Ankit Kansagra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Stephanie Farnia
- Center for Clinical Value, Blue Cross Blue Shield Association, Chicago, IL
| | - Navneet Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, OH
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DeFilipp Z, Advani AS, Bachanova V, Cassaday RD, Deangelo DJ, Kebriaei P, Rowe JM, Seftel MD, Stock W, Tallman MS, Fanning S, Inamoto Y, Kansagra A, Johnston L, Nagler A, Sauter CS, Savani BN, Perales MA, Carpenter PA, Larson RA, Weisdorf D. Hematopoietic Cell Transplantation in the Treatment of Adult Acute Lymphoblastic Leukemia: Updated 2019 Evidence-Based Review from the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2019; 25:2113-2123. [PMID: 31446198 DOI: 10.1016/j.bbmt.2019.08.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 01/05/2023]
Abstract
The role of hematopoietic cell transplantation (HCT) in adults with acute lymphoblastic leukemia (ALL) is reviewed and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published literature and for grading the quality and strength of the evidence and the strength of the recommendations. A panel of ALL experts developed consensus on the treatment recommendations based on the evidence. Allogeneic HCT offers a survival benefit in selected patients with ALL, and this review summarizes the standard indications as well as the areas of controversy. There is now greater experience with pediatric-inspired chemotherapy regimens that has transformed upfront therapy for adult ALL, resulting in higher remission rates and overall survival. This in turn has increased the equipoise around decision making for ALL in first complete remission (CR1) when there is no measurable residual disease (MRD) at the end of induction and/or consolidation. Randomized studies are needed for adults with ALL to compare allogeneic HCT in CR1 with pediatric-inspired chemotherapy alone. Indications for transplantation in the evolving landscape of MRD assessments and novel targeted and immune therapeutics remain important areas of investigation.
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Affiliation(s)
- Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA.
| | - Anjali S Advani
- Department of Medical Oncology & Hematology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Veronika Bachanova
- Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN
| | - Ryan D Cassaday
- Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Medicine, University of Washington, Seattle, WA, USA
| | - Daniel J Deangelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jacob M Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Wendy Stock
- Department of Hematology and Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Martin S Tallman
- Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Suzanne Fanning
- Hematology and Medical Oncology, Greenville Health System Cancer Institute, Greenville, SC
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Ankit Kansagra
- Department of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Laura Johnston
- Department of Medicine, Stanford University Medical Center, Stanford, CA
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Craig S Sauter
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Paul A Carpenter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Richard A Larson
- Department of Hematology and Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Daniel Weisdorf
- Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN
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Naddaf E, Milone M, Kansagra A, Buadi F, Kourelis T. Sporadic late-onset nemaline myopathy: Clinical spectrum, survival, and treatment outcomes. Neurology 2019; 93:e298-e305. [PMID: 31167932 DOI: 10.1212/wnl.0000000000007777] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/05/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe the clinical phenotype, long-term treatment outcome, and overall survival of sporadic late-onset nemaline myopathy (SLONM) with or without a monoclonal protein (MP). METHODS We conducted a retrospective chart review of patients seen between September 2000 and June 2017 and collected clinical, laboratory, and survival data. Treatment response was classified as mild, moderate, or marked as adjudged by predefined criteria. RESULTS We identified 28 patients with SLONM; 17 (61%) had an associated MP. Median age at symptom onset was 62 years. Diagnosis was often delayed by a median of 35 months from symptom onset. There was no difference in clinical or laboratory features between patients with or without MP. Although the majority of patients had proximal or axial weakness at onset, about 18% of patients had atypical presentations. A total of 7/9 (78%) patients receiving IV immunoglobulin (IVIg), 6/8 (75%) receiving hematologic therapy as either autologous stem cell transplant (ASCT) or chemotherapy, and 1/8 (13%) receiving immunosuppressive therapies responded to treatment (p = 0.001). All 3 patients with marked response were treated with IVIg; 2 of them had an MP. The 5-year and 10-year overall survival from symptom onset was 92% and 68%, respectively, with no difference between patients with or without MP. CONCLUSION SLONM has a wide spectrum of clinical presentations. In this contemporary case series, overall survival of patients did not seem to be affected by the presence of an MP. Initial treatment with IVIg is reasonable in all patients, followed by ASCT or chemotherapy as second-line therapy in patients with an associated MP.
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Affiliation(s)
- Elie Naddaf
- From the Department of Neurology, Division of Neuromuscular Medicine (E.N., M.M.), and Department of Internal Medicine, Division of Hematology (F.B., T.K.), Mayo Clinic, Rochester, MN; and Department of Internal Medicine, Division of Hematology (A.K.), University of Texas-Southwestern, Dallas.
| | - Margherita Milone
- From the Department of Neurology, Division of Neuromuscular Medicine (E.N., M.M.), and Department of Internal Medicine, Division of Hematology (F.B., T.K.), Mayo Clinic, Rochester, MN; and Department of Internal Medicine, Division of Hematology (A.K.), University of Texas-Southwestern, Dallas
| | - Ankit Kansagra
- From the Department of Neurology, Division of Neuromuscular Medicine (E.N., M.M.), and Department of Internal Medicine, Division of Hematology (F.B., T.K.), Mayo Clinic, Rochester, MN; and Department of Internal Medicine, Division of Hematology (A.K.), University of Texas-Southwestern, Dallas
| | - Francis Buadi
- From the Department of Neurology, Division of Neuromuscular Medicine (E.N., M.M.), and Department of Internal Medicine, Division of Hematology (F.B., T.K.), Mayo Clinic, Rochester, MN; and Department of Internal Medicine, Division of Hematology (A.K.), University of Texas-Southwestern, Dallas
| | - Taxiarchis Kourelis
- From the Department of Neurology, Division of Neuromuscular Medicine (E.N., M.M.), and Department of Internal Medicine, Division of Hematology (F.B., T.K.), Mayo Clinic, Rochester, MN; and Department of Internal Medicine, Division of Hematology (A.K.), University of Texas-Southwestern, Dallas
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Kansagra A, Gonsalves WI, Gertz MA, Buadi FK, Dingli D, Dispenzieri A, Lacy MQ, Hayman SR, Kapoor P, Muchtar E, Kourelis TV, Warsame R, Leung N, Zeldenrust SR, Lust JA, Rajkumar SV, Kyle RA, Hogan W, Kumar SK. Analysis of Clinical Factors and Outcomes Associated with Nonuse of Collected Peripheral Blood Stem Cells for Autologous Stem Cell Transplants in Transplant-Eligible Patients with Multiple Myeloma. Biol Blood Marrow Transplant 2018; 24:2127-2132. [DOI: 10.1016/j.bbmt.2018.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
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Naddaf E, Milone M, Kansagra A, Buadi F, Kourelis T. INFLAMMATORY MYOPATHIES. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.193] [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: 10/28/2022]
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Gupta A, Loh KP, Kansagra A, Shieh MS, Pekow P, Lindenauer P, Stefan M, Lagu T. Correspondence. J Natl Compr Canc Netw 2018; 14:li-lvi. [PMID: 27799517 DOI: 10.6004/jnccn.2016.0156] [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: 11/17/2022]
Affiliation(s)
| | - Kah Poh Loh
- Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York
| | - Ankit Kansagra
- Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Meng-Shiou Shieh
- Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts
| | - Penelope Pekow
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.,Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Peter Lindenauer
- Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts.,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Mihaela Stefan
- Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts.,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Tara Lagu
- Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts.,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
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Gonsalves WI, Kansagra A. Second Autologous Hematopoietic Stem Cell Transplant as Salvage Therapy for Relapsed Multiple Myeloma: A Global Treatment Option for Eligible Patients. Acta Haematol 2018; 139:45-46. [PMID: 29402801 DOI: 10.1159/000486272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 11/19/2022]
Affiliation(s)
| | - Ankit Kansagra
- Department of Medicine, Hematology, UT Southwestern, Dallas, Texas, USA
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Loh KP, Kansagra A, Shieh MS, Pekow P, Lindenauer P, Stefan M, Lagu T. Predictors of In-Hospital Mortality in Patients With Metastatic Cancer Receiving Specific Critical Care Therapies. J Natl Compr Canc Netw 2017; 14:979-87. [PMID: 27496114 DOI: 10.6004/jnccn.2016.0105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/20/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND In-hospital mortality is high for critically ill patients with metastatic cancer. To help patients, families, and clinicians make an informed decision about invasive medical treatments, we examined predictors of in-hospital mortality among patients with metastatic cancer who received critical care therapies (CCTs). PATIENTS AND METHODS We used the 2010 California Healthcare Cost and Utilization Project: State Inpatient Databases to identify admissions of patients with metastatic cancer (age ≥18 years) who received CCTs, including invasive mechanical ventilation (IMV), tracheostomy, percutaneous endoscopic gastrostomy (PEG) tube, acute use of dialysis, and total parenteral nutrition (TPN). We first described the characteristics and outcomes of patients who received any CCTs. We then used multivariable logistic regression models with generalized estimating equations (to account for clustering within hospitals) to identify predictors of in-hospital mortality among patients who received any CCTs. RESULTS For 2010, we identified 99,085 admissions among patients with metastatic cancer. Of these, 9,348 (9.4%) received any CCT during hospitalization; 50% received IMV, 15% PEG tube, 8% tracheostomy, 40% TPN, and 8% acute dialysis. Inpatient mortality was 30%. Of patients who received any CCT and survived to discharge, 27% were discharged to a skilled nursing facility. Compared with patients who died, costs of care were $3,019 higher for admissions in which patients survived the hospitalization. Predictors of in-hospital mortality included non-white race (vs whites), lack of insurance (vs Medicare), unscheduled admissions, principal diagnosis of infections (vs cancer-related), greater burden of comorbidities, end-stage renal disease, liver disease and lung cancer (vs other cancers). CONCLUSIONS Although more studies are needed to better understand risks and benefits of specific treatments in the setting of specific cancer types, these data will help to inform decision-making for patients with metastatic cancer who become critically ill.
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Affiliation(s)
- Kah Poh Loh
- From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Ankit Kansagra
- From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Meng-Shiou Shieh
- From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Penelope Pekow
- From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Peter Lindenauer
- From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Mihaela Stefan
- From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Tara Lagu
- From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts. From the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York; Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts; Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; and Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
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Abstract
Young adults with acute lymphoblastic leukemia are a distinctive category of patients, with substantial difference in disease biology and response to therapy; hence, they pose unique challenges and issues beyond those faced by children and older adults. Despite inferior survival compared to children, there is growing evidence to suggest that young adults have improved outcomes when treated with pediatric-based approaches. With better supportive care and toxicity management and multidisciplinary team and approach, we have made great improvement in outcomes of young adults with ALL. However, despite significant progress, patients with persistence of minimal residual disease have a poor prognosis. This review discusses current controversies in the management of young adults with ALL, outcomes following pediatric and adult protocols, and the role of allogeneic stem cell transplantation. We also explore recent advances in disease monitoring and highlight our approach to incorporation of novel therapies in the management of young adults with ALL.
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Affiliation(s)
- Ankit Kansagra
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mark Litzow
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Loh KP, Kansagra A, Shieh MS, Pekow P, Lindenauer P, Stefan M, Lagu T. Predictors of the Use of Specific Critical Care Therapies in Patients With Metastatic Cancer. J Natl Compr Canc Netw 2017; 15:22-30. [PMID: 28040717 DOI: 10.6004/jnccn.2017.0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/28/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Understanding which factors are associated with the use of critical care therapies (CCTs) can help with clinical decision-making and goals of care discussion. The goal of this study was to describe the predictors of CCT use (eg, mechanical ventilation, tracheostomy, percutaneous endoscopic gastrostomy tube, total parenteral nutrition, acute use of dialysis) in hospitalized patients with metastatic cancer. METHODS We used the 2010 California State Inpatient Databases sponsored by the Agency for Healthcare Research and Quality to identify all hospitalizations with a diagnosis of metastatic cancer (patients aged ≥18 years). We examined the predictors of any CCT use (and invasive mechanical ventilation [IMV] use), stratified by do-not-resuscitate (DNR) status, using multivariable logistic regression models. RESULTS We identified 99,085 hospitalizations involving patients with metastatic cancer; 9.4% received any CCTs and 4.7% received IMV. Predictors of CCT use in the no-DNR group included principal diagnosis of infections (vs cancer-related), greater burden of comorbidities, and presence of weight loss. Predictors of CCT use in the DNR group were similar, but also included non-white races. Liver disease was also a predictor of IMV use in the no-DNR group. Patients with metastatic lung cancer (vs breast and genitourinary) with no DNR were more likely to receive CCT (and IMV). CONCLUSIONS Higher burden of comorbidities, weight loss, liver disease, lung cancer subtype, and diagnosis of infections were associated with higher odds of receiving CCTs or IMV. These findings may help clinicians determine in whom to prioritize discussions around goals of care, especially in the group without a DNR status.
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Affiliation(s)
- Kah Poh Loh
- Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York
| | - Ankit Kansagra
- Division of Hematology/Oncology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Meng-Shiou Shieh
- Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts
| | - Penelope Pekow
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts,Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Peter Lindenauer
- Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Mihaela Stefan
- Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Tara Lagu
- Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
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Abstract
Conventional cytotoxic chemotherapy used to treat acute lymphoblastic leukemia (ALL) has resulted into high cure rates for pediatric patients, however outcomes for adult patients remain suboptimal. The 5-year overall survival is only 30-40% in adults and elderly patients with ALL compared to 90% in children. We have seen major advances in our understanding and management of ALL related to identification of new cytogenetic and molecular abnormalities and development of novel targeted agents for the treatment of ALL. The addition of tyrosine kinase inhibitors, monoclonal antibodies and novel immune therapies (e.g. bispecific T cell engager [BiTE] and chimeric antigen receptor [CAR] T cells) has resulted in improved outcomes. These new developments are changing the treatment paradigm of adults ALL from a 'one size fits all' approach to a more individualized treatment approach based on immunophenotypic, cytogenetic and molecular features. In this article we review recent diagnostic and therapeutic advances along with the challenges in the treatment of patients with ALL.
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Affiliation(s)
- Ankit Kansagra
- a Division of Hematology and Bone Marrow Transplant , Mayo Clinic , Rochester , MN , USA
| | - Saurabh Dahiya
- b Division of Blood and Marrow Transplant , Stanford University , Stanford , CA , USA
| | - Mark Litzow
- a Division of Hematology and Bone Marrow Transplant , Mayo Clinic , Rochester , MN , USA
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Yalniz FF, Hefazi M, McCullough K, Litzow MR, Hogan WJ, Wolf R, Alkhateeb H, Kansagra A, Damlaj M, Patnaik MM. Safety and Efficacy of Infliximab Therapy in the Setting of Steroid-Refractory Acute Graft-versus-Host Disease. Biol Blood Marrow Transplant 2017; 23:1478-1484. [PMID: 28495641 DOI: 10.1016/j.bbmt.2017.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 01/30/2017] [Accepted: 05/01/2017] [Indexed: 12/17/2022]
Abstract
Acute graft-versus-host disease (aGVHD) is the leading cause of morbidity and mortality after allogenic hematopoietic cell transplantation (HCT). Corticosteroids are the first-line treatment; however, less than one-half of patients achieve durable remission. Studies suggest that TNF-α, a cytokine released from the bone marrow during conditioning, is involved in the pathogenesis of aGVHD. We retrospectively evaluated the outcome of anti-TNF-α therapy with infliximab in 35 patients with steroid refractory (SR) aGVHD. Infliximab was administered intravenously at 10 mg/kg for a median of 4 doses (range, 1 to 6) on a weekly basis. The overall response rates were 40% (17% complete response [CR], 23% partial response [PR]) at 4 weeks, 23% (9% CR, 14% PR) at 8 weeks, and 17% (all CR) at 12 weeks. Twenty-nine (83%) patients had infectious complications within 12 weeks of initiation of infliximab. These infections included 40 bacterial infections, 6 invasive fungal infections, and 5 viral reactivations. Twelve patients (34%) died secondary to infections. Overall survival at 12 weeks and 6 months from the start of infliximab therapy was 37% (13 of 35) and 17% (6 of 35), respectively; with most deaths secondary to complications from GVHD and infections. In conclusion; the use of infliximab therapy in patients with SR-aGVHD is associated with a modest poorly sustained response along with a heightened risk of severe infections. Future studies with more effective and less toxic therapies are needed for these patients.
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Affiliation(s)
- Fevzi F Yalniz
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Mehrdad Hefazi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Robert Wolf
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | | | - Ankit Kansagra
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Moussab Damlaj
- Division of Hematology, King Abdulaziz University, Riyadh, Saudi Arabia
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Kansagra A, Andrzejewski C, Krushell R, Lehman A, Greenbaum J, Visintainer P, McGirr J, Mahoney K, Cloutier D, Ehresman A, Stefan MS. Blood Management Strategies to Reduce Transfusions After Elective Lower-Extremity Joint Arthroplasty Surgeries: One Tertiary Care Hospital’s Early Experience With an Alternative Payment Model—a Total Joint “Bundle”. Am J Med Qual 2017; 32:668-674. [DOI: 10.1177/1062860616687035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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
Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post. Fractional logistic regression was used to describe differences between various intervention periods. During the study period, 2511 patients underwent TJA. Compared with the preintervention period, there was 81.8% decrease in total units of RBCT during the postintervention period. Using activity-based costing (~$1000/unit), the annualized saving in RBC expenditure was $480 000. A multidisciplinary approach can be successful and sustainable in reducing RBCT and its associated costs for patients undergoing TJA.
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Affiliation(s)
- Ankit Kansagra
- Baystate Medical Center, Springfield, MA
- Tufts University School of Medicine, Boston, MA
| | - Chester Andrzejewski
- Baystate Medical Center, Springfield, MA
- Tufts University School of Medicine, Boston, MA
| | | | | | | | | | | | | | | | | | - Mihaela S. Stefan
- Baystate Medical Center, Springfield, MA
- Tufts University School of Medicine, Boston, MA
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Madaelil T, Moran C, Cross D, Kansagra A. O-021 Flow Diversion in Ruptured Intracranial Aneurysms: A Systematic Review. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.21] [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: 11/03/2022]
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