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Bourne G, Diebold K, Espinoza-Gutarra M, Al-Kadhimi Z, Bachiashvili K, Rangaraju S, Vachhani P, Bhatia R, Jamy O. Addition of single dose gemtuzumab ozogamicin to intensive induction chemotherapy in core-binding factor acute myeloid leukemia. Leuk Res 2024; 139:107467. [PMID: 38460432 DOI: 10.1016/j.leukres.2024.107467] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/23/2024] [Accepted: 02/24/2024] [Indexed: 03/11/2024]
Abstract
In a meta-analysis of 5 trials, the addition of gemtuzumab ozogamicin (GO) to intensive induction chemotherapy led to a survival benefit in patients with core-binding factor (CBF) acute myeloid leukemia (AML). Given the heterogeneous incorporation of GO in clinical trials, the ideal dose and schedule remains unclear. We conducted a single-center retrospective analysis to compare outcomes of patients with CBF-AML treated with intensive induction chemotherapy, with or without a single dose of GO 3 mg/m2, during induction only. We included 87 patients (GO=32, control=55). The composite complete remission (cCR) rate was higher in the control group (93%) compared to the GO group (82%) (p<0.001). The rate of measurable residual disease (MRD) negative cCR, by flow cytometry, was similar between both groups. There were no significant differences between the two groups in terms of toxicity. The 3-year relapse-free survival (RFS) for both groups was similar (71% vs 68%, p=0.5). The 3-year overall survival (OS) for the GO group was 68%, compared to 66% for the control group (p=0.9).In multivariable analysis, age and MRD positive status were risk factors for inferior outcomes. We find that survival of patients with CBF-AML is favorable in the real-world setting. The addition of single-dose GO, during induction, did not lead to a higher remission rate or survival benefit, when compared to intensive chemotherapy without GO. Further investigation into the incorporation of GO in the treatment algorithm for CBF-AML is needed.
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Affiliation(s)
- Garrett Bourne
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kendall Diebold
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Manuel Espinoza-Gutarra
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zaid Al-Kadhimi
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimo Bachiashvili
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sravanti Rangaraju
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ravi Bhatia
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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2
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Dunn-Valadez S, Bathini S, Purdy KE, Bachiashvili K, Bhatia R, Jamy O, Rangaraju S, Mehta A, Godby K, Goyal G, Worth S, Oliver JD, Mikhail FM, Choi JK, Morlote D, Reddy VB, Vachhani P. Utility of end of induction bone marrow biopsy and survival outcomes in acute promyelocytic leukemia treated with fixed-dose induction regimen. Leuk Lymphoma 2023; 64:1673-1680. [PMID: 37493540 DOI: 10.1080/10428194.2023.2234529] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 06/29/2023] [Indexed: 07/27/2023]
Abstract
Significant variations exist related to the end of induction practices in the management of Acute Promyelocytic Leukemia (APL). These variations include all-trans retinoic acid (ATRA)-arsenic trioxide (ATO) in fixed doses versus continuation until hematologic complete remission (CR) and performance versus omission of post-induction bone marrow biopsy to confirm morphological CR. A retrospective chart review was conducted of 61 patients (42 low/intermediate-risk and 19 high-risk) aged ≥ 18 years with newly diagnosed APL treated with fixed duration ATRA-ATO +/- cytoreduction at a tertiary medical center from December 2012 through March 2020. Of the 54 patients with post-induction bone marrow biopsy results, 52 (96%) demonstrated no morphologic evidence of APL while the remaining were equivocal. After 2.6 years median follow-up, no relapses occurred. The estimated 2-year overall survival rate of 95% suggests excellent outcomes with a fixed ATO induction regimen and safe omission of post-induction bone marrow biopsy irrespective of hematologic parameters.
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Affiliation(s)
- Sydney Dunn-Valadez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Srilakshmi Bathini
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathleen E Purdy
- Department of Medical Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimo Bachiashvili
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ravi Bhatia
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Omer Jamy
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sravanti Rangaraju
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amitkumar Mehta
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly Godby
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gaurav Goyal
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Worth
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Josh D Oliver
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fady M Mikhail
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John K Choi
- Division of Anatomic Pathology and Neuropathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Diana Morlote
- Division of Anatomic Pathology and Neuropathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishnu B Reddy
- Division of Anatomic Pathology and Neuropathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankit Vachhani
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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3
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Jamy O, Diebold K, Davis K, Bachiashvili K, Rangaraju S, Vachhani P, Godby KN, Salzman D, Bhatia R. Impact of induction intensity and transplantation on outcomes of patients with complex karyotype and TP53-mutated acute myeloid leukemia. Bone Marrow Transplant 2023; 58:823-825. [PMID: 37012416 DOI: 10.1038/s41409-023-01977-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kendall Diebold
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth Davis
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimo Bachiashvili
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sravanti Rangaraju
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly N Godby
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna Salzman
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ravi Bhatia
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Vazquez Guillamet LJ, Marx GE, Benjamin W, Pappas P, Lieberman NAP, Bachiashvili K, Leal S, Lieberman JA. Relapsing Fever Caused by Borrelia lonestari after Tick Bite in Alabama, USA. Emerg Infect Dis 2023; 29:441-444. [PMID: 36692856 PMCID: PMC9881794 DOI: 10.3201/eid2902.221281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We report an immunocompromised patient in Alabama, USA, 75 years of age, with relapsing fevers and pancytopenia who had spirochetemia after a tick bite. We identified Borrelia lonestari by using PCR, sequencing, and phylogenetic analysis. Increasing clinical availability of molecular diagnostics might identify B. lonestari as an emerging tickborne pathogen.
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5
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Zainaldin C, Arora S, Bathini S, Gupta U, Pandya V, Bae S, Worth S, Bachiashvili K, Bhatia R, Godby K, Jamy O, Rangaraju S, Diamond B, Oliver JD, Salzman D, Di Stasi A, Vachhani P. Dismal survival outcomes of patients with acute myeloid leukemia after failure of venetoclax with hypomethylating agents. Leuk Lymphoma 2022; 63:3245-3248. [PMID: 36107006 DOI: 10.1080/10428194.2022.2113530] [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: 01/12/2023]
Affiliation(s)
- Carl Zainaldin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sankalp Arora
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Srilakshmi Bathini
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Udita Gupta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishruti Pandya
- Divison of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Sejong Bae
- Divison of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Sarah Worth
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimo Bachiashvili
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Ravi Bhatia
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Kelly Godby
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Omer Jamy
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Sravanti Rangaraju
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Barry Diamond
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Josh D Oliver
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna Salzman
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Antonio Di Stasi
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Pankit Vachhani
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
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Ashraf S, Wolfson J, Vachhani P, Rangaraju S, Bachiashvili K, Bhatia R, Jamy O. Safe and Effective Use of Imatinib to Treat Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia During Pregnancy. J Adolesc Young Adult Oncol 2022; 11:617-620. [PMID: 35049365 DOI: 10.1089/jayao.2021.0200] [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] [Indexed: 12/16/2022] Open
Abstract
Philadelphia chromosome positive (Ph+) B cell acute lymphoblastic leukemia (ALL) is extremely rare in pregnancy. Although the use of tyrosine kinase inhibitors (TKIs) has significantly improved outcomes of patients with Ph+ ALL, its use during pregnancy is not recommended due to the risk of fetal malformations. There are limited data on the use of TKIs during pregnancy and its long-term effects on the fetus. Within this context, we present a case of a 25-year-old woman diagnosed with Ph+ ALL during the third trimester and the safe and effective use of imatinib as treatment after failure of conventional chemotherapy.
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Affiliation(s)
- Sarah Ashraf
- The Aga Khan University-Medical College, Karachi, Pakistan
| | - Julie Wolfson
- Division of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pankit Vachhani
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sravanti Rangaraju
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kimo Bachiashvili
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ravi Bhatia
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Omer Jamy
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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7
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Zainaldin C, Arora S, Bathini S, Pandya V, Bae S, Gupta U, Worth` S, Bachiashvili K, Bhatia R, Godby KN, Jamy O, Rangaraju S, Diamond B, Oliver JD, Salzman DE, Di Stasi A, Vachhani P. Survival outcomes of patients with relapsed or refractory acute myeloid leukemia after venetoclax combined with hypomethylating agents. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18808 Background: Venetoclax in combination with hypomethylating agents (HMA+Ven) is the standard-of-care treatment for patients with newly diagnosed acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy. HMA+Ven is also commonly used as salvage therapy for relapsed or refractory (R/R) AML. There is limited data regarding outcomes of AML patients after HMA+Ven failure. In clinical practice, survival following HMA+Ven failure, either as frontline or salvage therapy, is observed to be poor. Methods: We conducted a single center retrospective study to evaluate survival outcomes of AML patients who were R/R to HMA+Ven as frontline or salvage therapy. Patients ≥ 18 years of age with AML who initiated HMA+Ven between 06/2018 and 05/2021 were included. R/R AML was defined as clinically relevant disease with ≥ 5% blasts after prior complete remission/morphologic leukemia free state, refractoriness to at least two cycles of HMA+Ven, or progressive disease despite initiating HMA+Ven. Data cut-off was 02/07/2022. Overall survival (OS) was estimated using Kaplan-Meier method and outcome differences between sub-groups were assessed using the log rank test. Results: Forty-two patients met inclusion criteria. Baseline characteristics and treatment details are summarized in Table. The median OS of the overall cohort was 2.3 months (range 0.1-11.4). There was no significant difference in median OS between patients declared R/R to frontline vs salvage HMA+Ven (2.4 vs 1.8 months, hazard ratio [HR] = 0.84, 95% confidence interval [CI] 0.43-1.62). Patients who received treatment after HMA+Ven failure had longer median OS compared to patients who did not (n = 17, 4.7 vs 1.7 months, HR = 0.29, 95% CI 0.13-0.62). There was no significant difference in OS based on the sub-type of AML, ELN risk group, p53 mutation, or complex karyotype status. Conclusions: Data from our study support the clinical observation that AML patients with disease R/R to HMA+Ven, either as frontline or salvage therapy, have very poor survival outcomes. These results provide important prognostic information for clinicians and highlight the need for novel therapies for R/R AML.[Table: see text]
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Affiliation(s)
- Carl Zainaldin
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Sankalp Arora
- The University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Sri Bathini
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Vishruti Pandya
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Sejong Bae
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Udita Gupta
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Sarah Worth`
- University of Alabama at Birmingham, Department of Pharmacy, Birmingham, AL
| | - Kimo Bachiashvili
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Ravi Bhatia
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Kelly Nicole Godby
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Omer Jamy
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Sravanti Rangaraju
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Barry Diamond
- University of Alabama at Birmingham, Department of Pharmacy, Birmingham, AL
| | - Josh D Oliver
- University of Alabama at Birmingham, Department of Pharmacy, Birmingham, AL
| | - Donna E. Salzman
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Antonio Di Stasi
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Pankit Vachhani
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
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Vachhani P, Murthy GSG, Jamy O, Bachiashvili K, Rangaraju S, Cole T, Augelli-Szafran CE, Boohaker RJ, Moukha-Chafiq O, Hanks LJ, Stinson K, Jung DY, Atallah EL, Bhatia R. A phase 1 study of NTX-301, an oral DNMT1 inhibitor, in patients with MDS and AML (trial in progress). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps7077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS7077 Background: Patients with relapsed and/or refractory (r/r) myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), and acute myeloid leukemia (AML) who are not candidates for stem-cell transplantation have dismal outcomes. Novel therapies are needed. The nucleoside analogue NTX-301 (5-aza-4’-thio-2’-deoxycytidine or Aza-TdC) is incorporated into DNA, where it engages the active site of DNA methyltransferase I (DNMT1), a maintenance methyltransferase that contributes to the hypermethylation and silencing of tumor suppressor genes. DNMT1 can become trapped in a covalent complex with DNA, thus depleting free enzyme and inhibiting the normal maintenance methylation of CpG sites, resulting in re-activation of tumor suppressor genes. Preclinical data suggest a correlation between NTX-301 activity in leukemia xenograft models and decreased levels of DNMT1. NTX-301 offers an improvement over traditional DNA methyltransferase inhibitors (azacitidine, decitabine) by virtue of a higher incorporation rate into DNA at lower levels of cytotoxicity. Methods: This is a phase 1, open-label, multi-center, dose-escalation study to assess the safety, tolerability, and recommended myeloid monotherapy dose of NTX-301 in patients with r/r myeloid neoplasms. Patients ≥ 18 years with r/r higher-risk MDS (intermediate, high, very-high risk by IPSS-R), high-risk CMML (int-2/high by CPSS or CPSS-mol), or AML (marrow blasts ≤ 30% or WBC < 20,000 cells/µL without leukoreduction) are eligible. Other key eligibility criteria: Eastern Cooperative Oncology Group performance status 0–2; adequate cardiac, renal, and liver function; and resolved acute effects of any prior therapy. Successive cohorts of patients will receive escalating doses of NTX-301 starting from 2 mg QD. Each cycle is 21 days in duration (treatment for 5 days/week x 2 weeks and 1 week off). The trial incorporates accelerated titration design for dose level 1 and 2 followed by traditional 3+3 dose escalation design (3-6 patients per cohort) from dose level 3. Intrapatient dose escalation is allowed. NTX-301 treatment will continue until disease progression or unacceptable toxicity, whichever occurs first. Primary endpoints: incidence and severity of adverse events, dose-limiting toxicities (DLTs), maximum tolerated dose (MTD), biologically effective dose (BED). Secondary endpoints: PK parameters of NTX-301, PD assessment through global hypomethylation assay and other markers in blood and marrow, and clinical efficacy [overall response rate (ORR), complete remission (CR), marrow CR (mCR), partial remission (PR), stable disease (SD), hematologic improvement (HI) per mIWG criteria]. After the MTD/BED is identified, the safety and efficacy of NTX-301 will be explored further in selected myeloid malignancies. The study began enrolling patients in January 2021 and is still recruiting. Clinical trial information: NCT04167917.
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Affiliation(s)
- Pankit Vachhani
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | | | - Omer Jamy
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | | | - Sravanti Rangaraju
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Tonya Cole
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | | | - Ravi Bhatia
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
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Griffiths EA, Roy V, Alwan L, Bachiashvili K, Baird J, Cool R, Dinner S, Geyer M, Glaspy J, Gojo I, Hicks A, Kallam A, Kidwai WZ, Kloth DD, Kraut EH, Landsburg D, Lyman GH, Mahajan A, Miller R, Nachar V, Patel S, Patel S, Perez LE, Poust A, Riaz F, Rosovsky R, Rugo HS, Simon S, Vasu S, Wadleigh M, Westbrook K, Westervelt P, Berardi RA, Pluchino L. NCCN Guidelines® Insights: Hematopoietic Growth Factors, Version 1.2022. J Natl Compr Canc Netw 2022; 20:436-442. [PMID: 35545171 DOI: 10.6004/jnccn.2022.0026] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Hematopoietic Growth Factors provide recommendations for the appropriate use of growth factors in the clinical management of febrile neutropenia (FN), chemotherapy-induced thrombocytopenia (CIT), and chemotherapy-induced anemia (CIA). Management and prevention of these sequelae are an integral part of supportive care for many patients undergoing cancer treatment. The purpose of these guidelines is to operationalize the evaluation, prevention, and treatment of FN, CIT, and CIA in adult patients with nonmyeloid malignancies and to enable the patient and clinician to assess management options for FN, CIT, and CIA in the context of an individual patient's condition. These NCCN Guidelines Insights provide a summary of the important recent updates to the NCCN Guidelines for Hematopoietic Growth Factors, with particular emphasis on the incorporation of a newly developed section on CIT.
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Affiliation(s)
| | | | - Laura Alwan
- 3Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Rita Cool
- 6The University of Texas MD Anderson Cancer Center
| | - Shira Dinner
- 7Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Ivana Gojo
- 10The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Eric H Kraut
- 15The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Gary H Lyman
- 3Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Seema Patel
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Shiven Patel
- 21Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | - Hope S Rugo
- 26UCSF Helen Diller Family Comprehensive Cancer Center
| | - Shayna Simon
- 27UT Southwestern Simmons Comprehensive Cancer Center
| | - Sumithira Vasu
- 15The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Peter Westervelt
- 30Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; and
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10
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Jamy O, Lin K, Worth S, Bachiashvili K, Rangaraju S, Vachhani P, Bhatia R. Hypomethylating agent/venetoclax versus intensive chemotherapy in adults with relapsed or refractory acute myeloid leukaemia. Br J Haematol 2022; 198:e35-e37. [PMID: 35509246 DOI: 10.1111/bjh.18229] [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: 02/22/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Karen Lin
- Department of Medicine, Grandview Medical Center, Birmingham, Alabama, USA
| | - Sarah Worth
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Kimo Bachiashvili
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Sravanti Rangaraju
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Ravi Bhatia
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
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11
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Arora S, Zainaldin C, Bathini S, Gupta U, Worth S, Bachiashvili K, Bhatia R, Godby K, Jamy O, Rangaraju S, Diamond B, Oliver JD, Salzman D, Stasi AD, Vachhani P. CLO22-037: Tumor Lysis Syndrome and Infectious Complications During Induction With Venetoclax Combined With Azacitidine or Decitabine in Patients With Acute Myeloid Leukemia. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7292] [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)
- Sankalp Arora
- 1 University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Udita Gupta
- 1 University of Alabama at Birmingham, Birmingham, AL
| | - Sarah Worth
- 1 University of Alabama at Birmingham, Birmingham, AL
| | | | - Ravi Bhatia
- 1 University of Alabama at Birmingham, Birmingham, AL
| | - Kelly Godby
- 1 University of Alabama at Birmingham, Birmingham, AL
| | - Omer Jamy
- 1 University of Alabama at Birmingham, Birmingham, AL
| | | | - Barry Diamond
- 1 University of Alabama at Birmingham, Birmingham, AL
| | | | - Donna Salzman
- 1 University of Alabama at Birmingham, Birmingham, AL
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12
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Bal S, Narkhede M, Shea LK, Rangaraju S, Giri S, Vachhani P, Jamy O, Godby K, Goyal G, Ravi G, Bachiashvili K, Di Stasi A, Bhatia R, Salzman D, Mehta A, Costa LJ. Chimeric Antigen Receptor T Cells Mediated Toxicities Are Associated with Hyponatremia. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Bachiashvili K, Francisco L, Chen Y, Bosworth A, Forman SJ, Bhatia R, Bhatia S. Peripheral blood parameter abnormalities precede therapy-related myeloid neoplasms after autologous transplantation for lymphoma. Cancer 2021; 128:1392-1401. [PMID: 34962652 DOI: 10.1002/cncr.34072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Therapy-related myeloid neoplasms (t-MN) are a leading cause of nonrelapse mortality after autologous peripheral blood stem cell transplantation (aPBSCT) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphomas (NHL). t-MN patients treated at an earlier stage of disease evolution have a better prognosis, and this presents a need to identify patients at risk for t-MN. METHODS Using a prospective longitudinal study design, this study evaluated peripheral blood parameters pre-aPBSCT and on day 100, at 6 months, 1 year, 2 years, and 3 years in 304 patients treated with aPBSCT. The relation between peripheral blood parameters and subsequent development of t-MN was examined, and nomograms were developed to identify patients at risk for t-MN. RESULTS Twenty-one patients developed t-MN at a median of 1.95 years post-aPBSCT. Hemoglobin, hematocrit, white blood cell, and platelet counts were lower among patients who developed t-MN compared to those who did not; these differences appeared soon after aPBSCT, persisted, and preceded development of t-MN. Older age at aPBSCT (hazard ratio [HR]per_year_increase = 1.08, P = .007), exposure to total body irradiation (TBI) (HR = 2.90, P = .04), and low 100-day platelet count (HRincrease_per_unit_decline_in_PLT = 1.01, P = .002) predicted subsequent t-MN. These parameters and primary diagnosis allowed identification of patients at high risk of t-MN (eg, an HL patient undergoing aPBSCT at the age of 70 years with TBI and with a day 100 PLT between 100,000 and 150,000 would have a 62% probability of developing t-MN at 6 years post-aPBSCT). CONCLUSIONS Abnormalities in peripheral blood parameters can identify patients at high risk for t-MN after aPBSCT for HL or NHL, allowing opportunities to personalize close surveillance and possible disease-modifying interventions.
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Affiliation(s)
- Kimo Bachiashvili
- Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Stephen J Forman
- Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ravi Bhatia
- Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.,Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Magnusson T, Godby RC, Bachiashvili K, Jamy O. First report of novel heterozygous WRAP53 p.Ala522Glyfs*8 mutation associated dyskeratosis congenita. Br J Haematol 2021; 196:e27-e29. [PMID: 34649303 DOI: 10.1111/bjh.17883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tylan Magnusson
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard C Godby
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimo Bachiashvili
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Omer Jamy
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Arora S, Vachhani P, Bachiashvili K, Jamy O. Venetoclax with chemotherapy in relapse/refractory early T-cell precursor acute lymphoblastic leukemia. Leuk Lymphoma 2021; 62:2292-2294. [PMID: 33691573 DOI: 10.1080/10428194.2021.1897807] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sankalp Arora
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimo Bachiashvili
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Becker PS, Griffiths EA, Alwan LM, Bachiashvili K, Brown A, Cool R, Curtin P, Dinner S, Gojo I, Hicks A, Kallam A, Kidwai WZ, Kloth DD, Kraut EH, Landsburg D, Lyman GH, Miller R, Mukherjee S, Patel S, Perez LE, Poust A, Rampal R, Rosovsky R, Roy V, Rugo HS, Shayani S, Vasu S, Wadleigh M, Westbrook K, Westervelt P, Burns J, Keller J, Pluchino LA. NCCN Guidelines Insights: Hematopoietic Growth Factors, Version 1.2020. J Natl Compr Canc Netw 2021; 18:12-22. [PMID: 31910384 DOI: 10.6004/jnccn.2020.0002] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management of febrile neutropenia (FN) is an integral part of supportive care for patients undergoing cancer treatment. The NCCN Guidelines for Hematopoietic Growth Factors provide suggestions for appropriate evaluation, risk determination, prophylaxis, and management of FN. These NCCN Guidelines are intended to guide clinicians in the appropriate use of growth factors for select patients undergoing treatment of nonmyeloid malignancies. These NCCN Guidelines Insights highlight important updates to the NCCN Guidelines regarding the incorporation of newly FDA-approved granulocyte-colony stimulating factor biosimilars for the prevention and treatment of FN.
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Affiliation(s)
| | | | - Laura M Alwan
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Anna Brown
- University of Michigan Rogel Cancer Center
| | - Rita Cool
- The University of Texas MD Anderson Cancer Center
| | | | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Ivana Gojo
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Eric H Kraut
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Sudipto Mukherjee
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Shiven Patel
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | - Hope S Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Sumithira Vasu
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Peter Westervelt
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; and
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17
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Griffiths EA, Alwan LM, Bachiashvili K, Brown A, Cool R, Curtin P, Geyer MB, Gojo I, Kallam A, Kidwai WZ, Kloth DD, Kraut EH, Lyman GH, Mukherjee S, Perez LE, Rosovsky RP, Roy V, Rugo HS, Vasu S, Wadleigh M, Westervelt P, Becker PS. Considerations for Use of Hematopoietic Growth Factors in Patients With Cancer Related to the COVID-19 Pandemic. J Natl Compr Canc Netw 2020; 19:1-4. [PMID: 32871558 PMCID: PMC9730290 DOI: 10.6004/jnccn.2020.7610] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/25/2020] [Indexed: 12/15/2022]
Abstract
Hematopoietic growth factors, including erythrocyte stimulating agents (ESAs), granulocyte colony-stimulating factors, and thrombopoietin mimetics, can mitigate anemia, neutropenia, and thrombocytopenia resulting from chemotherapy for the treatment of cancer. In the context of pandemic SARS-CoV-2 infection, patients with cancer have been identified as a group at high risk of morbidity and mortality from this infection. Our subcommittee of the NCCN Hematopoietic Growth Factors Panel convened a voluntary group to review the potential value of expanded use of such growth factors in the current high-risk environment. Although recommendations are available on the NCCN website in the COVID-19 Resources Section (https://www.nccn.org/covid-19/), these suggestions are provided without substantial context or reference. Herein we review the rationale and data underlying the suggested alterations to the use of hematopoietic growth factors for patients with cancer in the COVID-19 era.
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Affiliation(s)
| | - Laura M. Alwan
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington
| | - Kimo Bachiashvili
- O’Neal Comprehensive Cancer Center at the University of Alabama, Birmingham, Alabama
| | - Anna Brown
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | - Rita Cool
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter Curtin
- UC San Diego Moores Cancer Center, La Jolla, California
| | - Mark B. Geyer
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ivana Gojo
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Avyakta Kallam
- University of Nebraska Medical Center, Fred & Pamela Buffett Cancer Center, Omaha, Nebraska
| | - Wajih Z. Kidwai
- Yale Cancer Center/Smilow Cancer Hospital, New Haven, Connecticut
| | | | - Eric H. Kraut
- The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Gary H. Lyman
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington
| | - Sudipto Mukherjee
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | | | | | - Vivek Roy
- Mayo Clinic Cancer Center; Jacksonville, Florida
| | - Hope S. Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Sumithira Vasu
- The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Martha Wadleigh
- Dana Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Peter Westervelt
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, Missouri
| | - Pamela S. Becker
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington
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18
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Attarian S, Reed L, Singh S, Shestopalov A, Singh AP, Budhathoki A, Abi-Aad S, Shah UA, Kim S, Bachiashvili K, Elrafei T, Li W, Yee C, Friedman EW. Visualization of the bone marrow biopsy needle track. Am J Hematol 2018; 93:E60-E61. [PMID: 29168229 DOI: 10.1002/ajh.24985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 11/20/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Shirin Attarian
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Louis Reed
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Shashi Singh
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | | | - Aditi P Singh
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Anjali Budhathoki
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Simon Abi-Aad
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Urvi A Shah
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Salem Kim
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Kimo Bachiashvili
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Tarek Elrafei
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Weijuan Li
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Conway Yee
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
| | - Ellen W Friedman
- Department of Hematology/Oncology; Montefiore Medical Center; Bronx NY 10467
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19
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Anampa J, Haque T, Murakhovskaya I, Wang Y, Bachiashvili K, Papazoglu C, Pradhan K, Steidl UG, Sparano JA, Verma A. Macrocytosis and dysplastic anemia is associated with the cyclin-dependent kinase 4/6 inhibitor palbociclib in metastatic breast cancer. Haematologica 2017; 103:e98-e102. [PMID: 29191840 DOI: 10.3324/haematol.2017.181941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jesus Anampa
- Department of Oncology, Section of Breast Medical Oncology, Montefiore Medical Center, NY, USA
| | - Tamanna Haque
- Department of Oncology, Section of Breast Medical Oncology, Montefiore Medical Center, NY, USA
| | - Irina Murakhovskaya
- Department of Oncology, Division of Hematology, Montefiore Medical Center, NY, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, NY, USA
| | - Kimo Bachiashvili
- Department of Oncology, Section of Breast Medical Oncology, Montefiore Medical Center, NY, USA
| | - Cristian Papazoglu
- Department of Oncology, Section of Breast Medical Oncology, Montefiore Medical Center, NY, USA
| | - Kith Pradhan
- Department of Developmental & Molecular Biology, NY, USA
| | - Ulrich G Steidl
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joseph A Sparano
- Department of Oncology, Section of Breast Medical Oncology, Montefiore Medical Center, NY, USA
| | - Amit Verma
- Department of Oncology, Division of Hematology, Montefiore Medical Center, NY, USA.,Department of Developmental & Molecular Biology, NY, USA
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20
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Reed L, Attarian S, Pendurti G, Singh AP, Budhathoki A, Abi-Aad S, Shah UA, Kim S, Bachiashvili K, Moon JY, Kim M, Elrafei T, Alexis K, Strakhan M, Li W, Friedman E. Targeting the anterior superior iliac spine yields significantly longer bone marrow cores. J Clin Pathol 2017; 71:172-173. [PMID: 28844037 DOI: 10.1136/jclinpath-2017-204686] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 11/04/2022]
Abstract
Pathologists and haematologists generally agree that the length of the biopsy core is a good surrogate for the diagnostic quality of the bone marrow. Previous studies suggested that the angulation of the biopsy needle from the posterior superior iliac spine (PSIS) could influence the length of the biopsy cores, targeting the anterior superior iliac spine (ASIS) from the PSIS would yield longer specimens than the traditional angulation technique (TAT), where the biopsy needle is directed straight in, perpendicular to the plane of the back. Twenty five adult haematology patients were prospectively recruited by haematologists-in-training (HITs), who were trained to target the ASIS using a lateral angulationtechnique (LAT). The mean length of biopsy cores was 16 mm and that was significantly longer (p=0.003) than a comparable group of bone marrow biopsies previously obtained by HITs using the TAT approach. These results support the LAT as a new standard of haematology practice. TRIAL REGISTRATION NUMBER NCT 02524613.
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Affiliation(s)
- Louis Reed
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shirin Attarian
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Hematology and Oncology, Montefiore Medical Center, Bronx, New York, USA
| | - Gopichand Pendurti
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Aditi P Singh
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Hematology and Oncology, Montefiore Medical Center, Bronx, New York, USA
| | - Anjali Budhathoki
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Hematology and Oncology, Montefiore Medical Center, Bronx, New York, USA
| | - Simon Abi-Aad
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Hematology and Oncology, Montefiore Medical Center, Bronx, New York, USA
| | - Urvi A Shah
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Hematology and Oncology, Montefiore Medical Center, Bronx, New York, USA
| | - Salem Kim
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Hematology and Oncology, Montefiore Medical Center, Bronx, New York, USA
| | - Kimo Bachiashvili
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Hematology and Oncology, Montefiore Medical Center, Bronx, New York, USA
| | - Jee Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tarek Elrafei
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Karenza Alexis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marianna Strakhan
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Weijuan Li
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ellen Friedman
- Department of Hematology and Oncology, Montefiore Medical Center, Bronx, New York, USA
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21
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Bachiashvili K, Horton JA, Damron TA. Evaluation of hedgehog pathway inhibitors on alveolar rhabdomyosarcoma. J Am Coll Surg 2011. [DOI: 10.1016/j.jamcollsurg.2011.06.351] [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: 10/17/2022]
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