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Lin C, Schwarzbach A, Sanz J, Montesinos P, Stiff P, Parikh S, Brunstein C, Cutler C, Lindemans CA, Hanna R, Koh LP, Jagasia MH, Valcarcel D, Maziarz RT, Keating AK, Hwang WYK, Rezvani AR, Karras NA, Fernandes JF, Rocha V, Badell I, Ram R, Schiller GJ, Volodin L, Walters MC, Hamerschlak N, Cilloni D, Frankfurt O, McGuirk JP, Kurtzberg J, Sanz G, Simantov R, Horwitz ME. Multicenter Long-Term Follow-Up of Allogeneic Hematopoietic Cell Transplantation with Omidubicel: A Pooled Analysis of Five Prospective Clinical Trials. Transplant Cell Ther 2023; 29:338.e1-338.e6. [PMID: 36775201 PMCID: PMC10149622 DOI: 10.1016/j.jtct.2023.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
Omidubicel is an umbilical cord blood (UCB)-derived ex vivo-expanded cellular therapy product that has demonstrated faster engraftment and fewer infections compared with unmanipulated UCB in allogeneic hematopoietic cell transplantation. Although the early benefits of omidubicel have been established, long-term outcomes remain unknown. We report on a planned pooled analysis of 5 multicenter clinical trials including 105 patients with hematologic malignancies or sickle cell hemoglobinopathy who underwent omidubicel transplantation at 26 academic transplantation centers worldwide. With a median follow-up of 22 months (range, .3 to 122 months), the 3-year estimated overall survival and disease-free survival were 62.5% and 54.0%, respectively. With up to 10 years of follow-up, omidubicel showed durable trilineage hematopoiesis. Serial quantitative assessments of CD3+, CD4+, CD8+, CD19+, CD116+CD56+, and CD123+ immune subsets revealed median counts remaining within normal ranges through up to 8 years of follow-up. Secondary graft failure occurred in 5 patients (5%) in the first year, with no late cases reported. One case of donor-derived myeloid neoplasm was reported at 40 months post-transplantation. This was also observed in a control arm patient who received only unmanipulated UCB. Overall, omidubicel demonstrated stable trilineage hematopoiesis, immune competence, and graft durability in extended follow-up.
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Affiliation(s)
- Chenyu Lin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Jaime Sanz
- Hematology Department, Hospital Universitario y Polit
| | | | - Patrick Stiff
- Division of Hematology and Oncology, Loyola University Medical Center, Chicago, Illinois
| | | | - Claudio Brunstein
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota; Department of Hematology and Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | - Corey Cutler
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Caroline A Lindemans
- Department of Pediatric Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rabi Hanna
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic, Cleveland, Ohio
| | - Liang Piu Koh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Madan H Jagasia
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Valcarcel
- Department of Haematology and Haemotherapy, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Richard T Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Amy K Keating
- Blood and Marrow Transplantation, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - William Y K Hwang
- Department of Haematology, National Cancer Centre Singapore, Singapore; Department of Haematology, Singapore General Hospital, Singapore; Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore
| | - Andrew R Rezvani
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University School of Medicine, Stanford, California
| | - Nicole A Karras
- Department of Pediatrics, City of Hope National Medical Center, Duarte, California
| | | | | | - Isabel Badell
- Pediatric Haematology and Stem Cell Transplantation Unit, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Ron Ram
- BMT Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gary J Schiller
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Leonid Volodin
- Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | - Mark C Walters
- Benioff Children's Hospital, University of California San Francisco, Oakland, California
| | | | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Olga Frankfurt
- Division of Hematology and Oncology, Northwestern University, Chicago, Illinois
| | - Joseph P McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, Kansas
| | - Joanne Kurtzberg
- Division of Hematology-Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Guillermo Sanz
- Hematology Department, Hospital Universitario y Polit; Health Reserach Institute La Fe, Valencia, Spain; CIBERONC, ISCIII, Madrid, Spain
| | | | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
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2
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Kluger HM, Sarnaik A, Chesney JA, Lewis KD, Weber JS, Gogas H, In GK, Terheyden PAM, Lee S, Jagasia MH, Masteller E, Qi R, Gontcharova V, Shi W, Fiaz R, Sulur G, Wu RX, Chen G, Thomas SS. Tumor mutational burden (TMB) in immune checkpoint inhibitor (ICI)-naïve and -experienced patients with metastatic melanoma treated with lifileucel, a tumor-infiltrating lymphocyte (TIL) cell therapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9524] [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
9524 Background: Cutaneous melanoma is characterized by high TMB, which is associated with increased tumor-specific neoantigen expression (Schumacher Science 2015) and an increased response rate to ICI (Yarchoan NEJM 2019). The TMB in tumors that recur/progress after ICI is not well defined. Lifileucel is a one-time, autologous TIL cell therapy under investigation for treatment of patients (pts) with advanced melanoma. We conducted a matched case-control study of prospectively enrolled pts with advanced melanoma treated with lifileucel in the ICI-naïve (IOV-COM-202 trial, Cohort 1A [C1A]) and post-ICI (C-144-01 trial, Cohort 2 [C2]) setting to investigate the potential association between prior ICI therapy, TMB, and response to lifileucel. Methods: All pts had unresectable or metastatic melanoma. Available cases from C1A (ICI-naïve pts receiving lifileucel + pembrolizumab [pembro]) were matched to controls from C2 (pts receiving lifileucel alone after progression on antiPD-1/PD-L1 therapy); 3 controls per case were matched at least for BRAF status and disease stage at study entry, and if possible, for anatomic site of tumor harvest. Lifileucel regimen was similar in C1A and C2. In C1A, 1 dose of pembro was given after tumor harvest and before nonmyeloablative lymphodepletion and resumed after lifileucel per standard treatment, for up to 2 y. Objective response rate (ORR) was assessed by investigators per RECIST v1.1. TMB of the resected tumor was measured using the ImmunoID NeXT (C1A) or PGDx elio (C2) platform; a validated conversion factor was used to compare TMB between platforms (Vega Ann Oncol 2021). High TMB was defined as ≥10 mut/MB. Results: Seven pts in C1A and 21 in C2 were included in the case-control study and had ORR of 71.4% and 38.1%, respectively. The percentage of pts with high TMB was 57.1% in C1A and 19.0% in C2 ( P = 0.1). ORR in the low and high TMB groups was 66.7% and 75.0%, respectively, in C1A and 41.1% and 25.0% in C2; 60% of responders in C1A and 12.5% in C2 had high TMB. In logistic regression analysis adjusted for cohort, TMB was not associated with response to lifileucel (odds ratio, 1.0; 95% CI, 0.91.1; P = 0.8). Data on tumor mutations and neoantigens, T-cell receptor repertoire, and tumor microenvironment profile will be presented. Conclusions: Our preliminary data indicate that the efficacy (ORR) of lifileucel may be independent of TMB, regardless of treatment setting, consistent with its proposed immune checkpoint pathway-independent mechanism of action. The percentage of patients with high TMB tended to be lower in tumors with prior ICI exposure than in those that were ICI-naïve. Clinical trial information: NCT03645928; NCT02360579.
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Affiliation(s)
- Harriet M. Kluger
- Yale University School of Medicine, Smilow Cancer Center, New Haven Hospital, New Haven, CT
| | | | - Jason Alan Chesney
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - Karl D. Lewis
- University of Colorado Cancer Center—Anschutz Medical Campus, Aurora, CO
| | - Jeffrey S. Weber
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | - Helen Gogas
- National and Kapodistrian University of Athens, Athens, Greece
| | - Gino Kim In
- Norris Comprehensive Cancer Center of University of Southern California, Los Angeles, CA
| | | | - Sylvia Lee
- University of Washington School of Medicine, Seattle, WA
| | | | | | - Rongsu Qi
- Iovance Biotherapeutics, Inc., San Carlos, CA
| | | | - Wen Shi
- Iovance Biotherapeutics, Inc., San Carlos, CA
| | - Rana Fiaz
- Iovance Biotherapeutics, Inc., San Carlos, CA
| | - Giri Sulur
- Iovance Biotherapeutics, Inc., San Carlos, CA
| | | | - Guang Chen
- Iovance Biotherapeutics, Inc., San Carlos, CA
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3
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Yeh AC, Varelias A, Reddy A, Barone SM, Olver SD, Chilson K, Onstad LE, Ensbey KS, Henden AS, Samson L, Jaeger CA, Bi T, Dahlman KB, Kim TK, Zhang P, Degli-Esposti MA, Newell EW, Jagasia MH, Irish JM, Lee SJ, Hill GR. CMV exposure drives long-term CD57+ CD4 memory T-cell inflation following allogeneic stem cell transplant. Blood 2021; 138:2874-2885. [PMID: 34115118 PMCID: PMC8718626 DOI: 10.1182/blood.2020009492] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/14/2020] [Accepted: 05/22/2021] [Indexed: 01/01/2023] Open
Abstract
Donor and recipient cytomegalovirus (CMV) serostatus correlate with transplant-related mortality that is associated with reduced survival following allogeneic stem cell transplant (SCT). Prior epidemiologic studies have suggested that CMV seronegative recipients (R-) receiving a CMV-seropositive graft (D+) experience inferior outcomes compared with other serostatus combinations, an observation that appears independent of viral reactivation. We therefore investigated the hypothesis that prior donor CMV exposure irreversibly modifies immunologic function after SCT. We identified a CD4+/CD57+/CD27- T-cell subset that was differentially expressed between D+ and D- transplants and validated results with 120 patient samples. This T-cell subset represents an average of 2.9% (D-/R-), 18% (D-/R+), 12% (D+/R-), and 19.6% (D+/R+) (P < .0001) of the total CD4+ T-cell compartment and stably persists for at least several years post-SCT. Even in the absence of CMV reactivation post-SCT, D+/R- transplants displayed a significant enrichment of these cells compared with D-/R- transplants (P = .0078). These are effector memory cells (CCR7-/CD45RA+/-) that express T-bet, Eomesodermin, granzyme B, secrete Th1 cytokines, and are enriched in CMV-specific T cells. These cells are associated with decreased T-cell receptor diversity (P < .0001) and reduced proportions of major histocompatibility class (MHC) II expressing classical monocytes (P < .0001), myeloid (P = .024), and plasmacytoid dendritic cells (P = .0014). These data describe a highly expanded CD4+ T-cell population and putative mechanisms by which prior donor or recipient CMV exposure may create a lasting immunologic imprint following SCT, providing a rationale for using D- grafts for R- transplant recipients.
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Affiliation(s)
- Albert C Yeh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Antiopi Varelias
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Facuty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Sierra M Barone
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN
| | - Stuart D Olver
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kate Chilson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lynn E Onstad
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kathleen S Ensbey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Andrea S Henden
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Luke Samson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Carla A Jaeger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Timothy Bi
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kimberly B Dahlman
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; and
| | - Tae Kon Kim
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; and
| | - Ping Zhang
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mariapia A Degli-Esposti
- Infection and Immunity Program, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Evan W Newell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Madan H Jagasia
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; and
| | - Jonathan M Irish
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Geoffrey R Hill
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
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4
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de Koning C, Tao W, Lacna A, van Veghel K, Horwitz ME, Sanz G, Jagasia MH, Wagner JE, Stiff PJ, Hanna R, Cilloni D, Valcárcel D, Peled T, Galamidi Cohen E, Goshen U, Pandit A, Lindemans CA, Jan Boelens J, Nierkens S. Lymphoid and myeloid immune cell reconstitution after nicotinamide-expanded cord blood transplantation. Bone Marrow Transplant 2021; 56:2826-2833. [PMID: 34312498 PMCID: PMC8563413 DOI: 10.1038/s41409-021-01417-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Omidubicel (nicotinamide-expanded cord blood) is a potential alternative source for allogeneic hematopoietic cell transplantation (HCT) when an HLA-identical donor is lacking. A phase I/II trial with standalone omidubicel HCT showed rapid and robust neutrophil and platelet engraftment. In this study, we evaluated the immune reconstitution (IR) of patients receiving omidubicel grafts during the first 6 months post-transplant, as IR is critical for favorable outcomes of the procedure. Data was collected from the omidubicel phase I-II international, multicenter trial. The primary endpoint was the probability of achieving adequate CD4+ T-cell IR (CD4IR: > 50 × 106/L within 100 days). Secondary endpoints were the recovery of T-cells, natural killer (NK)-cells, B-cells, dendritic cells (DC), and monocytes as determined with multicolor flow cytometry. LOESS-regression curves and cumulative incidence plots were used for data description. Thirty-six omidubicel recipients (median 44; 13-63 years) were included, and IR data was available from 28 recipients. Of these patients, 90% achieved adequate CD4IR. Overall, IR was complete and consisted of T-cell, monocyte, DC, and notably fast NK- and B-cell reconstitution, compared to conventional grafts. Our data show that transplantation of adolescent and adult patients with omidubicel results in full and broad IR, which is comparable with IR after HCT with conventional graft sources.
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Affiliation(s)
- Coco de Koning
- University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Weiyang Tao
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Amelia Lacna
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Guillermo Sanz
- Hospital Universitario y Politécnico la Fe, València, Spain
- Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Caroline A Lindemans
- University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jaap Jan Boelens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefan Nierkens
- University Medical Center Utrecht, Utrecht, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
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5
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Thomas SS, In GK, Doger B, Haefliger S, Martin-Liberal J, Goldberg Z, Cacovean A, Fiaz R, Chen G, Jagasia MH, Graf Finckenstein F, Fardis M, Jimeno A. Safety and efficacy of lifileucel (LN-144), an autologous, tumor infiltrating lymphocyte cell therapy in combination with pembrolizumab for immune checkpoint inhibitor naïve patients with advanced melanoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9537] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9537 Background: Tumor infiltrating lymphocyte (TIL) cell therapy has demonstrated safety and efficacy in advanced melanoma, both in the pre-immune checkpoint inhibitor (ICI) setting (Goff, JCO 2016) and in patients who have failed anti-PD-1/PD-L1 therapy (Sarnaik, 2020). Combination of TIL and pembrolizumab (pembro) in ICI-naïve patients has demonstrated encouraging efficacy data with acceptable safety in head and neck squamous cell carcinoma (Jimeno, 2020). To improve treatment options in early lines, we explore a combination of LN-144 and pembro in patients with ICI-naïve advanced melanoma. Methods: IOV-COM-202 is a Phase 2 multicenter, multi-cohort, open-label study evaluating TIL cell therapy in multiple settings and indications. We report on Cohort 1A enrolling ICI-naïve advanced melanoma (unresectable or metastatic) patients for treatment with a combination of LN-144 and pembro. Key eligibility criteria include ≤ 3 lines of prior therapy, ECOG < 2, one resectable lesion for lifileucel manufacturing, and ≥ 1 measurable lesion for response assessment. Primary endpoints are objective response rate (ORR) per RECIST 1.1 and safety as measured by incidence of Grade ≥3 treatment-emergent adverse events (TEAE). LN-144 is generated at centralized GMP facilities in a 22-day process. A nonmyeloablative lymphodepletion (NMA-LD) using cyclophosphamide and fludarabine is administered preceding a single LN-144 infusion, followed by < 6 doses of IL-2 (600,000 IU/kg). Pembro is administered after tumor harvest but prior to NMA-LD and continues after lifileucel per label. Results: Seven patients have received lifileucel in combination with pembro as of data extraction date (Feb 14, 2021). Five of the 7 treated patients were treatment-naïve, 1 patient had prior BRAFi + MEKi and 1 had received prior chemotherapy; 71% had liver/brain lesions, 43% had LDH > ULN. Mean SOD for the target lesions was 111 mm, with 86% of patients with > 3 target lesions, representing advanced disease at baseline for this patient group. The TEAE profile was consistent with the underlying disease and known AE profiles of pembro, NMA-LD and IL-2. Six patients had a confirmed objective response with an ORR of 86% (1 CR, 5 PR) and 1 best response of SD. Three of the responding patients have remained off pembro due to pembro related AEs for 3, 4 and 13 months (mos), yet maintaining response. All responding patients remain in response with the longest duration of response being 16.8 mos. Conclusions: Lifileucel can be safely combined with pembro in patients with ICI-naïve advanced melanoma. The ORR of 86% is encouraging when compared to pembro alone in a similar patient population, especially considering the disease burden at baseline and persistence of responses in patients off therapy. Enrollment is ongoing and updated data to be presented. Clinical trial information: NCT03645928.
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Affiliation(s)
| | - Gino Kim In
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Bernard Doger
- Hospital Universitario Fundacion Jimenez Diaz - START Madrid, Madrid, Spain
| | | | | | | | | | - Rana Fiaz
- Iovance Biotherapeutics, Inc., San Carlos, CA
| | - Guang Chen
- Iovance Biotherapeutics, Inc., San Carlos, CA
| | | | | | | | - Antonio Jimeno
- University of Colorado Comprehensive Cancer Center, Aurora, CO
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6
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Elgarten CW, Li Y, Getz KD, Hemmer M, Huang YSV, Hall M, Wang T, Kitko CL, Jagasia MH, Nishihori T, Murthy HS, Hashem H, Cairo MS, Sharma A, Hashmi SK, Askar M, Beitinjaneh A, Kelly MS, Auletta JJ, Badawy SM, Mavers M, Aplenc R, MacMillan ML, Spellman SR, Arora M, Fisher BT. Broad-Spectrum Antibiotics and Risk of Graft-versus-Host Disease in Pediatric Patients Undergoing Transplantation for Acute Leukemia: Association of Carbapenem Use with the Risk of Acute Graft-versus-Host Disease. Transplant Cell Ther 2020; 27:177.e1-177.e8. [PMID: 33718896 DOI: 10.1016/j.jtct.2020.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Variation in the gastrointestinal (GI) microbiota after hematopoietic cell transplantation (HCT) has been associated with acute graft-versus-host disease (aGVHD). Because antibiotics induce dysbiosis, we examined the association of broad-spectrum antibiotics with subsequent aGVHD risk in pediatric patients undergoing HCT for acute leukemia. We performed a retrospective analysis in a dataset merged from 2 sources: (1) the Center for International Blood and Marrow Transplant Research, an observational transplantation registry, and (2) the Pediatric Health Information Services, an administrative database from freestanding children's hospitals. We captured exposure to 3 classes of antibiotics used for empiric treatment of febrile neutropenia: (1) broad-spectrum cephalosporins, (2) antipseudomonal penicillins, and (3) carbapenems. The primary outcome was grade II-IV aGVHD; secondary outcomes were grade III-IV aGVHD and lower GI GVHD. The adjusted logistic regression model (full cohort) and time-to-event analysis (subcohort) included transplantation characteristics, GVHD risk factors, and adjunctive antibiotic exposures as covariates. The full cohort included 2550 patients at 36 centers; the subcohort included 1174 patients. In adjusted models, carbapenems were associated with an increased risk of grade II-IV aGVHD in the full cohort (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.02 to 1.51) and subcohort (sub hazard ratio [HR], 1.31; 95% CI, 0.99 to 1.72), as well as with an increased risk of grade III-IV aGVHD (subHR, 1.77; 95% CI, 1.25 to 2.52). Early carbapenem exposure (before day 0) especially impacted aGVHD risk. For antipseudomonal penicillins, the associations with aGVHD were in the direction of increased risk but were not statistically significant. There was no identified association between broad-spectrum cephalosporins and aGVHD. Carbapenems, more than other broad-spectrum antibiotics, should be used judiciously in pediatric HCT recipients to minimize aGVHD risk. Further research is needed to clarify the mechanism underlying this association.
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Affiliation(s)
- Caitlin W Elgarten
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Yimei Li
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
| | - Kelly D Getz
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
| | | | - Yuan-Shung V Huang
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Tao Wang
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Carrie L Kitko
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Hasan Hashem
- Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Mitchell S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN
| | - Shahrukh K Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN.,Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Medhat Askar
- Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami, Miami, FL
| | - Matthew S Kelly
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, NC
| | - Jeffery J Auletta
- Blood and Marrow Transplant Program and Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Melissa Mavers
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Bass Center for Childhood Cancer and Blood Diseases, Stanford University School of Medicine, Palo Alto, CA
| | - Richard Aplenc
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
| | - Margaret L MacMillan
- Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN
| | - Brian T Fisher
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA.,Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA
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7
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Chen F, Dellalana LE, Gandelman JS, Vain A, Jagasia MH, Tkaczyk ER. Correction: Non-invasive measurement of sclerosis in cutaneous cGVHD patients with the handheld device Myoton: a cross-sectional study. Bone Marrow Transplant 2020; 55:992. [DOI: 10.1038/s41409-020-0780-1] [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: 11/09/2022]
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8
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Waller EK, Miklos D, Cutler C, Arora M, Jagasia MH, Pusic I, Flowers ME, Logan AC, Nakamura R, Chang S, Clow F, Lal ID, Styles L, Jaglowski S. Ibrutinib for Chronic Graft-versus-Host Disease After Failure of Prior Therapy: 1-Year Update of a Phase 1b/2 Study. Biol Blood Marrow Transplant 2019; 25:2002-2007. [PMID: 31260802 DOI: 10.1016/j.bbmt.2019.06.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 12/14/2022]
Abstract
Chronic graft-versus-host disease (cGVHD) is a life-threatening complication of allogeneic stem cell transplantation. In a Phase 1b/2, open-label study (PCYC-1129; ClinicalTrials.gov identifier NCT02195869) involving 42 patients with active cGVHD who were steroid-dependent or -refractory, the activity and safety of ibrutinib, a once-daily inhibitor of Bruton's tyrosine kinase, was demonstrated. Here we report extended follow-up for patients in this study. After a median follow-up of 26 months (range, .53 to 36.7 months), best overall response rate in the all treated population was 69% (29 of 42), with 13 patients (31%) achieving a complete response and 16 patients (38%) achieving a partial response. Sustained responses of ≥20, ≥32, and ≥44 weeks were seen in 20 (69%), 18 (62%), and 16 (55%) of the 29 responders, respectively. Of 26 patients with ≥2 involved organs, 19 (73%) showed responses in ≥2 organs. Six of 10 patients (60%) with ≥3 involved organs showed responses in ≥3 organs. Eleven of 18 patients (61%) who had sclerosis at baseline showed a sclerotic response (39% with complete response, 22% with partial response). Twenty-seven of 42 patients (64%) reached a corticosteroid dose of <.15 mg/kg/day during the study; 8 discontinued corticosteroid treatment and remained off corticosteroid at study closure. Safety findings for this updated analysis were consistent with the safety profile seen at the time of the original analysis. Common grade ≥3 adverse events (AEs) were pneumonia (n = 6), fatigue (n = 5), and diarrhea (n = 4). The onset of new grade ≥3 AEs decreased from 71% in the first year of treatment to 25% in the second year (n = 12). AEs leading to discontinuation occurred in 18 patients (43%). At a median follow-up of >2 years, ibrutinib continued to produce durable responses in patients with cGVHD who had failed previous systemic therapy. In this pretreated, high-risk population, clinically meaningful benefit and an acceptable safety profile were observed with additional follow-up for ibrutinib. These results demonstrate a substantial advance in the therapeutic management of patients with cGVHD.
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9
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Martin PJ, Storer BE, Palmer J, Jagasia MH, Chen GL, Broady R, Arora M, Pidala JA, Hamilton BK, Lee SJ. Organ Changes Associated with Provider-Assessed Responses in Patients with Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2019; 25:1869-1874. [PMID: 31085305 PMCID: PMC6755054 DOI: 10.1016/j.bbmt.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
Assessments of overall improvement and worsening of chronic graft-versus-host disease (GVHD) manifestations by the algorithm recommended by National Institutes of Health (NIH) response criteria do not align closely with those reported by providers, particularly when patients have mixed responses with improvement in some manifestations but worsening in others. To elucidate the changes that influence provider assessment of response, we used logistic regression to generate an overall change index based on specific manifestations of chronic GVHD measured at baseline and 6 months later. We hypothesized that this overall change index would correlate strongly with overall improvement as determined by providers. The analysis included 488 patients from 2 prospective observational studies who were randomly assigned in a 3:2 ratio to discovery and replication cohorts. Changes in bilirubin and scores of the lower gastrointestinal tract, mouth, joint/fascia, lung, and skin were correlated with provider-assessed improvement, suggesting that the main NIH response measures capture relevant information. Conversely, changes in the eye, esophagus, and upper gastrointestinal tract did not correlate with provider-assessed response, suggesting that these scales could be modified or dropped from the NIH response assessment. The area under the receiver operator characteristic curve in the replication cohort was 0.72, indicating that the scoring algorithm for overall change based on NIH response measures is not well calibrated with provider-assessed response.
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Affiliation(s)
- Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
| | - Barry E Storer
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Madan H Jagasia
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - George L Chen
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Raewyn Broady
- Leukemia/Bone Marrow Transplant Program of British Columbia, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Mukta Arora
- Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Joseph A Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Betty K Hamilton
- Blood and Marrow Transplantation, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
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10
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Pidala JA, Hamilton BK, Martin PJ, Onstad L, Storer BE, Palmer J, Alousi A, Cutler C, Jagasia MH, Chen GL, Arora M, Flowers ME, Lee SJ. The Chronic Graft-versus-Host Disease Failure-Free Survival (cGVHD-FFS) Index. Biol Blood Marrow Transplant 2019; 25:2468-2473. [PMID: 31394265 DOI: 10.1016/j.bbmt.2019.07.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/10/2019] [Accepted: 07/25/2019] [Indexed: 11/18/2022]
Abstract
In clinical trials of chronic graft-versus-host disease (cGVHD), the need to start a new systemic treatment is considered a treatment failure. A composite endpoint called "failure-free survival" (FFS), where events are initiation of a new systemic cGVHD treatment, recurrent malignancy, and death, has been suggested as a possible long-term indicator of success. The goal of the current study was to identify changes in cGVHD manifestations from baseline to 6 months that could accurately predict subsequent longer-term FFS, thereby making it possible to assess outcomes earlier than would otherwise be possible. We used data from 2 prospective, multicenter, observational studies to develop the cGVHD-FFS index. The cGVHD-FFS index was calculated at 6 months, a typical timepoint for assessment of the primary endpoint of phase II cGVHD trials. Subsequent FFS was only 45% within the next 2 years. We found that changes in the scores for the eyes, joint/fascia, and mouth ulcers from baseline to 6 months were associated with subsequent FFS, but the prognostic accuracy of these changes was not adequate for use in trials. Biomarker studies might help to identify criteria that improve prediction of long-term clinical outcomes in patients with cGVHD.
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Affiliation(s)
- Joseph A Pidala
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Betty K Hamilton
- Blood and Marrow Transplantation, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Lynn Onstad
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Barry E Storer
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Amin Alousi
- Department of Stem Cell Transplant and Cellular Therapy, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Corey Cutler
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Madan H Jagasia
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - George L Chen
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Mukta Arora
- Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
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11
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Tkaczyk ER, Coco JR, Wang J, Chen F, Ye C, Jagasia MH, Dawant BM, Fabbri D. Crowdsourcing to delineate skin affected by chronic graft-vs-host disease. Skin Res Technol 2019; 25:572-577. [PMID: 30786065 DOI: 10.1111/srt.12688] [Citation(s) in RCA: 5] [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: 11/14/2018] [Revised: 01/05/2019] [Accepted: 01/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Estimating the extent of affected skin is an important unmet clinical need both for research and practical management in many diseases. In particular, cutaneous burden of chronic graft-vs-host disease (cGVHD) is a primary outcome in many trials. Despite advances in artificial intelligence and 3D photography, progress toward reliable automated techniques is hindered by limited expert time to delineate cGVHD patient images. Crowdsourcing may have potential to provide the requisite expert-level data. MATERIALS AND METHODS Forty-one three-dimensional photographs of three cutaneous cGVHD patients were delineated by a board-certified dermatologist. 410 two-dimensional projections of the raw photos were each annotated by seven crowd workers, whose consensus performance was compared to the expert. RESULTS The consensus delineation by four of seven crowd workers achieved the highest agreement with the expert, measured by a median Dice index of 0.7551 across all 410 images, outperforming even the best worker from the crowd (Dice index 0.7216). For their internal agreement, crowd workers achieved a median Fleiss's kappa of 0.4140 across the images. The time a worker spent marking an image had only weak correlation with the surface area marked, and very low correlation with accuracy. Percent of pixels selected by the consensus exhibited good correlation (Pearson R = 0.81) with the patient's affected surface area. CONCLUSION Crowdsourcing may be an efficient method for obtaining demarcations of affected skin, on par with expert performance. Crowdsourced data generally agreed with the current clinical standard of percent body surface area to assess cGVHD severity in the skin.
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Affiliation(s)
- Eric R Tkaczyk
- Department of Veterans Affairs, Tennessee Valley Health System, Nashville, Tennessee.,Department of Dermatology, Vanderbilt Cutaneous Imaging Clinic, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Joseph R Coco
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jianing Wang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Fuyao Chen
- Department of Veterans Affairs, Tennessee Valley Health System, Nashville, Tennessee.,Department of Dermatology, Vanderbilt Cutaneous Imaging Clinic, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Cheng Ye
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
| | | | - Benoit M Dawant
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
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12
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Chen F, Dellalana LE, Gandelman JS, Vain A, Jagasia MH, Tkaczyk ER. Non-invasive measurement of sclerosis in cutaneous cGVHD patients with the handheld device Myoton: a cross-sectional study. Bone Marrow Transplant 2018; 54:616-619. [PMID: 30287938 DOI: 10.1038/s41409-018-0346-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/23/2018] [Accepted: 09/05/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Fuyao Chen
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Laura E Dellalana
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jocelyn S Gandelman
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arved Vain
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA.,Institute of Physics, University of Tartu, Tartu, Estonia
| | - Madan H Jagasia
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric R Tkaczyk
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA. .,Dermatology Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA.
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13
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Gandelman JS, Byrne MT, Mistry AM, Polikowsky HG, Diggins KE, Chen H, Lee SJ, Arora M, Cutler C, Flowers M, Pidala J, Irish JM, Jagasia MH. Machine learning reveals chronic graft- versus-host disease phenotypes and stratifies survival after stem cell transplant for hematologic malignancies. Haematologica 2018; 104:189-196. [PMID: 30237265 PMCID: PMC6312024 DOI: 10.3324/haematol.2018.193441] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022] Open
Abstract
The application of machine learning in medicine has been productive in multiple fields, but has not previously been applied to analyze the complexity of organ involvement by chronic graft-versus-host disease. Chronic graft-versus-host disease is classified by an overall composite score as mild, moderate or severe, which may overlook clinically relevant patterns in organ involvement. Here we applied a novel computational approach to chronic graft-versus-host disease with the goal of identifying phenotypic groups based on the subcomponents of the National Institutes of Health Consensus Criteria. Computational analysis revealed seven distinct groups of patients with contrasting clinical risks. The high-risk group had an inferior overall survival compared to the low-risk group (hazard ratio 2.24; 95% confidence interval: 1.36-3.68), an effect that was independent of graft-versus-host disease severity as measured by the National Institutes of Health criteria. To test clinical applicability, knowledge was translated into a simplified clinical prognostic decision tree. Groups identified by the decision tree also stratified outcomes and closely matched those from the original analysis. Patients in the high- and intermediate-risk decision-tree groups had significantly shorter overall survival than those in the low-risk group (hazard ratio 2.79; 95% confidence interval: 1.58-4.91 and hazard ratio 1.78; 95% confidence interval: 1.06-3.01, respectively). Machine learning and other computational analyses may better reveal biomarkers and stratify risk than the current approach based on cumulative severity. This approach could now be explored in other disease models with complex clinical phenotypes. External validation must be completed prior to clinical application. Ultimately, this approach has the potential to reveal distinct pathophysiological mechanisms that may underlie clusters. Clinicaltrials.gov identifier: NCT00637689.
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Affiliation(s)
- Jocelyn S Gandelman
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN.,Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Michael T Byrne
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Akshitkumar M Mistry
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Hannah G Polikowsky
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Kirsten E Diggins
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Corey Cutler
- Stem Cell/Bone Marrow Transplantation Program, Dana-Farber Cancer Institute, Boston, MA
| | - Mary Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Joseph Pidala
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jonathan M Irish
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN .,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Madan H Jagasia
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN .,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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14
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Gandelman JS, Zic J, Dewan AK, Lee SJ, Flowers M, Cutler C, Pidala J, Chen H, Jagasia MH, Tkaczyk ER. The Anatomic Distribution of Skin Involvement in Patients with Incident Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2018; 25:279-286. [PMID: 30219700 DOI: 10.1016/j.bbmt.2018.09.007] [Citation(s) in RCA: 6] [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: 06/12/2018] [Accepted: 09/06/2018] [Indexed: 01/15/2023]
Abstract
Little is known about the anatomic distribution of cutaneous chronic graft-versus-host disease (cGVHD). Using data from the cGVHD Consortium Improving Outcomes Assessment Study, we describe the frequency and extent of erythema and superficial and deep sclerosis in 8 anatomic sites in patients with incident disease (ie, new cGVHD diagnosis within 3 months of study entry) receiving systemic therapy. Of 339 patients with incident disease, 182 (54%) had skin involvement. When an extremity was involved, the same type of disease was present contralaterally in 92% of cases, revealing a high level of symmetry. As anticipated, erythema was the most common incident feature; however, sclerotic skin involvement at the time of cGVHD diagnosis was more common than has been suggested by previous studies. Erythema occurred in 155 (85%) and sclerosis in 53 (29%) of the patients with skin involvement (46% and 16%, respectively, of the entire cohort of 339 incident cGVHD cases). Erythema was least common on the lower extremities (n = 71; 39% of patients with skin involvement). Moveable sclerosis was rare on the head, neck, and scalp (n = 4; 2%). Deep sclerosis did not occur in this region, and instead was most likely to occur on the upper extremities (n = 14; 8%) and lower extremities (n = 14; 8%). More than one-half of patients with erythema (n = 107; 58.7%) had diffuse involvement (4 or more of 8 sites involved), compared with less than one-third of those with sclerosis (n = 16; 30.2%).
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Affiliation(s)
- Jocelyn S Gandelman
- Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee; Vanderbilt University School of Medicine, Nashville, Tennessee
| | - John Zic
- Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anna K Dewan
- Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Corey Cutler
- Stem Cell/Bone Marrow Transplantation Program, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph Pidala
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Madan H Jagasia
- Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric R Tkaczyk
- Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee; Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.
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15
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Holtan SG, DeFor TE, Panoskaltsis-Mortari A, Khera N, Levine JE, Flowers MED, Lee SJ, Inamoto Y, Chen GL, Mayer S, Arora M, Palmer J, Cutler CS, Arai S, Lazaryan A, Newell LF, Jagasia MH, Pusic I, Wood WA, Renteria AS, Yanik G, Hogan WJ, Hexner E, Ayuk F, Holler E, Bunworasate U, Efebera YA, Ferrara JLM, Pidala J, Howard A, Wu J, Bolaños-Meade J, Ho V, Alousi A, Blazar BR, Weisdorf DJ, MacMillan ML. Amphiregulin modifies the Minnesota Acute Graft-versus-Host Disease Risk Score: results from BMT CTN 0302/0802. Blood Adv 2018; 2:1882-1888. [PMID: 30087106 PMCID: PMC6093743 DOI: 10.1182/bloodadvances.2018017343] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/26/2018] [Indexed: 01/07/2023] Open
Abstract
Amphiregulin (AREG) is an epidermal growth factor receptor ligand that can restore integrity to damaged intestinal mucosa in murine models of acute graft-versus-host disease (aGVHD). We previously reported that circulating AREG is elevated in late-onset aGVHD (occurring after 100 days posttransplant), but its clinical relevance in the context of aGVHD risk is unknown. We measured AREG in 251 aGVHD onset blood samples from Blood and Marrow Clinical Trials Network (BMT CTN) primary treatment trials and determined their association with GVHD severity, day 28 complete or partial response (CR/PR) to first-line therapy, overall survival (OS), and nonrelapse mortality (NRM). Every doubling of plasma AREG was associated with a 33% decrease in the odds of day 28 CR/PR (odds ratio [OR], 0.67; P < .01). An AREG threshold of 33 pg/mL or greater divided patients with Minnesota standard-risk (SR) aGVHD into a distinct group with a significantly lower likelihood of: day 28 CR/PR (72% vs 85%; P = .02); greater 2-year NRM (42% vs 15%; P < .01); and inferior OS (40% vs 66%; P < .01). High AREG ≥ 33 pg/mL also stratified patients with Minnesota high-risk (HR) aGVHD: day 28 CR/PR (54% vs 83%; P = .03) and 2-year NRM (53% vs 11%; P < .01), with a trend toward inferior 2-year OS (37% vs 60%; P = .09). High-circulating AREG (≥33 pg/mL) reclassifies patients into HR subgroups and thereby further refines the Minnesota aGVHD clinical risk score.
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Affiliation(s)
- Shernan G Holtan
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | - Todd E DeFor
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | | | | | - John E Levine
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - George L Chen
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Sebastian Mayer
- Department of Medicine, Weill Cornell Medical Center, New York, NY
| | - Mukta Arora
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | | | - Corey S Cutler
- Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Sally Arai
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
| | - Aleksandr Lazaryan
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | - Laura F Newell
- Center for Hematologic Malignancies, Oregon Health and Science University, Portland, OR
| | - Madan H Jagasia
- Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Iskra Pusic
- Medical Oncology, Washington University Medical Center, St. Louis, MO
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Anne S Renteria
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gregory Yanik
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI
| | - William J Hogan
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, MN
| | - Elizabeth Hexner
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Germany
| | - Ernst Holler
- Blood and Marrow Transplantation Program, University of Regensburg, Regensburg, Germany
| | - Udomsak Bunworasate
- Blood and Marrow Transplantation Program, Chulalongkorn University, Bangkok, Thailand
| | - Yvonne A Efebera
- Blood and Marrow Transplantation Program, The Ohio State University, Columbus, OH
| | - James L M Ferrara
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Alan Howard
- National Marrow Donor Program, Minneapolis, MN
| | - Juan Wu
- The EMMES Corporation, Rockville, MD
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and
| | - Vincent Ho
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
| | | | - Bruce R Blazar
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | - Daniel J Weisdorf
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
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16
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Soiffer RJ, Chen YBA, Jagasia MH. Reply to J.J. Boelens et al. J Clin Oncol 2018; 36:1176-1177. [PMID: 29412783 DOI: 10.1200/jco.2017.77.2939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Robert J Soiffer
- Robert J. Soiffer, Dana-Farber Cancer Institute, Boston, MA; Yi-Bin A. Chen, Massachusetts General Hospital, Boston, MA; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Yi-Bin A Chen
- Robert J. Soiffer, Dana-Farber Cancer Institute, Boston, MA; Yi-Bin A. Chen, Massachusetts General Hospital, Boston, MA; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Madan H Jagasia
- Robert J. Soiffer, Dana-Farber Cancer Institute, Boston, MA; Yi-Bin A. Chen, Massachusetts General Hospital, Boston, MA; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
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Soiffer RJ, Kim HT, McGuirk J, Horwitz ME, Johnston L, Patnaik MM, Rybka W, Artz A, Porter DL, Shea TC, Boyer MW, Maziarz RT, Shaughnessy PJ, Gergis U, Safah H, Reshef R, DiPersio JF, Stiff PJ, Vusirikala M, Szer J, Holter J, Levine JD, Martin PJ, Pidala JA, Lewis ID, Ho VT, Alyea EP, Ritz J, Glavin F, Westervelt P, Jagasia MH, Chen YB. Prospective, Randomized, Double-Blind, Phase III Clinical Trial of Anti-T-Lymphocyte Globulin to Assess Impact on Chronic Graft-Versus-Host Disease-Free Survival in Patients Undergoing HLA-Matched Unrelated Myeloablative Hematopoietic Cell Transplantation. J Clin Oncol 2017; 35:4003-4011. [PMID: 29040031 DOI: 10.1200/jco.2017.75.8177] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [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
Purpose Several open-label randomized studies have suggested that in vivo T-cell depletion with anti-T-lymphocyte globulin (ATLG; formerly antithymocyte globulin-Fresenius) reduces chronic graft-versus-host disease (cGVHD) without compromising survival. We report a prospective, double-blind phase III trial to investigate the effect of ATLG (Neovii Biotech, Lexington, MA) on cGVHD-free survival. Patients and Methods Two hundred fifty-four patients 18 to 65 years of age with acute leukemia or myelodysplastic syndrome who underwent myeloablative HLA-matched unrelated hematopoietic cell transplantation (HCT) were randomly assigned one to one to placebo (n =128 placebo) or ATLG (n = 126) treatment at 27 sites. Patients received either ATLG or placebo 20 mg/kg per day on days -3, -2, -1 in addition to tacrolimus and methotrexate as GVHD prophylaxis. The primary study end point was moderate-severe cGVHD-free survival. Results Despite a reduction in grade 2 to 4 acute GVHD (23% v 40%; P = .004) and moderate-severe cGVHD (12% v 33%; P < .001) in ATLG recipients, no difference in moderate-severe cGVHD-free survival between ATLG and placebo was found (2-year estimate: 48% v 44%, respectively; P = .47). Both progression-free survival (PFS) and overall survival (OS) were lower with ATLG (2-year estimate: 47% v 65% [ P = .04] and 59% v 74% [ P = .034], respectively). Multivariable analysis confirmed that ATLG was associated with inferior PFS (hazard ratio, 1.55; 95% CI, 1.05 to 2.28; P = .026) and OS (hazard ratio, 1.74; 95% CI, 1.12 to 2.71; P = .01). Conclusion In this prospective, randomized, double-blind trial of ATLG in unrelated myeloablative HCT, the incorporation of ATLG did not improve moderate-severe cGVHD-free survival. Moderate-severe cGVHD was significantly lower with ATLG, but PFS and OS also were lower. Additional analyses are needed to understand the appropriate role for ATLG in HCT.
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Affiliation(s)
- Robert J Soiffer
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Haesook T Kim
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph McGuirk
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Mitchell E Horwitz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Laura Johnston
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Mrinal M Patnaik
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Witold Rybka
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew Artz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - David L Porter
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas C Shea
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Michael W Boyer
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Richard T Maziarz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Paul J Shaughnessy
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Usama Gergis
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Hana Safah
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Ran Reshef
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - John F DiPersio
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Patrick J Stiff
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Madhuri Vusirikala
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Jeff Szer
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer Holter
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - James D Levine
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Paul J Martin
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph A Pidala
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Ian D Lewis
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Vincent T Ho
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Edwin P Alyea
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Jerome Ritz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Frank Glavin
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Peter Westervelt
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Madan H Jagasia
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Yi-Bin Chen
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
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18
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Abana CO, Pilkinton MA, Gaudieri S, Chopra A, McDonnell WJ, Wanjalla C, Barnett L, Gangula R, Hager C, Jung DK, Engelhardt BG, Jagasia MH, Klenerman P, Phillips EJ, Koelle DM, Kalams SA, Mallal SA. Cytomegalovirus (CMV) Epitope-Specific CD4 + T Cells Are Inflated in HIV + CMV + Subjects. J Immunol 2017; 199:3187-3201. [PMID: 28972094 DOI: 10.4049/jimmunol.1700851] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/28/2017] [Indexed: 01/24/2023]
Abstract
Select CMV epitopes drive life-long CD8+ T cell memory inflation, but the extent of CD4 memory inflation is poorly studied. CD4+ T cells specific for human CMV (HCMV) are elevated in HIV+ HCMV+ subjects. To determine whether HCMV epitope-specific CD4+ T cell memory inflation occurs during HIV infection, we used HLA-DR7 (DRB1*07:01) tetramers loaded with the glycoprotein B DYSNTHSTRYV (DYS) epitope to characterize circulating CD4+ T cells in coinfected HLA-DR7+ long-term nonprogressor HIV subjects with undetectable HCMV plasma viremia. DYS-specific CD4+ T cells were inflated among these HIV+ subjects compared with those from an HIV- HCMV+ HLA-DR7+ cohort or with HLA-DR7-restricted CD4+ T cells from the HIV-coinfected cohort that were specific for epitopes of HCMV phosphoprotein-65, tetanus toxoid precursor, EBV nuclear Ag 2, or HIV gag protein. Inflated DYS-specific CD4+ T cells consisted of effector memory or effector memory-RA+ subsets with restricted TCRβ usage and nearly monoclonal CDR3 containing novel conserved amino acids. Expression of this near-monoclonal TCR in a Jurkat cell-transfection system validated fine DYS specificity. Inflated cells were polyfunctional, not senescent, and displayed high ex vivo levels of granzyme B, CX3CR1, CD38, or HLA-DR but less often coexpressed CD38+ and HLA-DR+ The inflation mechanism did not involve apoptosis suppression, increased proliferation, or HIV gag cross-reactivity. Instead, the findings suggest that intermittent or chronic expression of epitopes, such as DYS, drive inflation of activated CD4+ T cells that home to endothelial cells and have the potential to mediate cytotoxicity and vascular disease.
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Affiliation(s)
- Chike O Abana
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232
| | - Mark A Pilkinton
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Silvana Gaudieri
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232.,School of Human Sciences, University of Western Australia, Perth, Western Australia 6009, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia 6150, Australia
| | - Abha Chopra
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia 6150, Australia
| | - Wyatt J McDonnell
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232
| | - Celestine Wanjalla
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Louise Barnett
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Rama Gangula
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Cindy Hager
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Dae K Jung
- Stem Cell Transplantation, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Brian G Engelhardt
- Stem Cell Transplantation, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Madan H Jagasia
- Stem Cell Transplantation, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, United Kingdom; and
| | - Elizabeth J Phillips
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232.,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia 6150, Australia
| | - David M Koelle
- Department of Medicine, Laboratory Medicine, and Global Health, University of Washington, Seattle, WA 98195
| | - Spyros A Kalams
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Simon A Mallal
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232; .,Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232.,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia 6150, Australia
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19
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Miklos DB, Jagasia MH, Greinix H, Ko BS, Jacobsohn DA, Mokatrin A, Dubovsky J, Horn B, Hauns B, Styles LA, Flowers M. A randomized, double-blind phase III study of ibrutinib versus placebo in combination with corticosteroids in patients with new onset chronic graft versus host disease. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps7072] [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] [Indexed: 11/20/2022] Open
Abstract
TPS7072 Background: Chronic graft versus host disease (cGVHD) is a common complication of allogeneic stem cell transplantation, with pathophysiology involving alloreactive and dysregulated T and B cells and innate immune populations. Ibrutinib, a first-in-class, once-daily inhibitor of Bruton's tyrosine kinase, is indicated by the US FDA for the treatment of patients (pts) with CLL/SLL. Ibrutinib recently received breakthrough therapy and orphan drug designation for the treatment of pts with cGVHD who did not respond to one or more lines of systemic therapy. Ibrutinib reduces severity of cGVHD in murine models and recently was shown to achieve an NIH-defined overall response rate of 67% in pts with steroid relapsed/refractory cGVHD (Miklos Blood 2016). Methods: The primary objective of this Phase 3, multicenter, international, randomized, controlled, double-blind study is to evaluate the 24-week response rate of ibrutinib versus placebo in combination with prednisone. Pts with newly diagnosed moderate or severe cGVHD, as per NIH Consensus Development Project Criteria (2014), will be randomized in a 1:1 ratio to receive either oral ibrutinib (arm A) or placebo (arm B) in combination with oral prednisone. Ibrutinib or placebo will be given until unacceptable toxicity, relapse of underlying disease, death, or the need for a new systemic treatment for progressive cGVHD. Eligible study pts (age ≥12 yrs) must require systemic treatment with corticosteroids and have no prior systemic treatment for cGVHD. The primary endpoint is response rate (complete or partial response) at 24 weeks, as per NIH Consensus Development Project Criteria, and must occur in the absence of both new therapy for cGVHD and relapse/return of the underlying disease that was the indication for transplant. Secondary endpoints will assess for additional clinical benefit including corticosteroid dose reduction, improvement of Lee cGVHD Symptom Scale scores, withdrawal of all immunosuppressants, and overall survival. This study is currently enrolling pts. Funding source: Pharmacyclics LLC, an AbbVie Company. Clinical trial information: NCT02959944.
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Affiliation(s)
| | | | | | - Bor-Sheng Ko
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | - Biljana Horn
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | | | - Mary Flowers
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA
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20
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Horwitz M, Montesinos P, Kurtzberg J, Valcarcel D, Jagasia MH, Cilloni D, Boelens JJ, Sanz GF. NiCord single unit expanded umbilical cord blood transplantation: Results of phase I/II trials. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Pau Montesinos
- Hospital Universitari i Politecnic La Fe de Valencia, Valencia, Spain
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21
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Nilanthi Johnpulle RA, Paczesny S, Jung DK, Daguindau E, Jagasia MH, Savani BN, Chinratanalab W, Cornell RF, Goodman S, Greer J, Kassim AA, Sengsayadeth S, Engelhardt BG. Metabolic Complications Precede Alloreactivity and are Characterized by Changes in ST2 Signaling. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Krupski MC, Bodiford A, Culos K, Kassim AA, Engelhardt BG, Greer J, Savani BN, Chinratanalab W, Jagasia MH. Tacrolimus Metabolism and Risk of Acute Graft-Versus-Host-Disease. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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El-Jawahri A, Wood B, Cutler CS, Pidala JA, Flowers ME, Arora M, Jagasia MH, Palmer J, Chen YB, Lee SJ. Self-Reported Depression and Anxiety By Patients with Chronic Graft-Versus-Host Disease Identify a Group with Worse Quality of Life, Symptoms, and Functional Status. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.309] [Citation(s) in RCA: 2] [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: 11/16/2022]
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24
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Arora M, Cutler CS, Jagasia MH, Pidala J, Chai X, Martin PJ, Flowers MED, Inamoto Y, Chen GL, Wood WA, Khera N, Palmer J, Duong H, Arai S, Mayer S, Pusic I, Lee SJ. Late Acute and Chronic Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:449-55. [PMID: 26541363 PMCID: PMC4787270 DOI: 10.1016/j.bbmt.2015.10.018] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/20/2015] [Indexed: 11/24/2022]
Abstract
Several distinct graft-versus-host disease (GVHD)-related syndromes have been defined by the National Institutes of Health Consensus Conference. We enrolled a prospective cohort of 911 hematopoietic cell transplantation (HCT) recipients at 13 centers between March 2011 and May 2014 to evaluate 4 GVHD syndromes: late acute GVHD (aGVHD), chronic GVHD (cGVHD), bronchiolitis obliterans syndrome, and cutaneous sclerosis. The median age at HCT was 53.7 years. The majority of patients received a peripheral blood stem cell transplant (81%) following nonmyeloablative or reduced-intensity conditioning (55%). Pediatric age group and use of bone marrow and umbilical cord blood grafts were underrepresented in our cohort (≤11%). The cumulative incidence of late aGVHD (late onset and recurrent) was 10% at a median of 5.5 months post-HCT, that of cGVHD was 47% at a median of 7.4 months, that of bronchiolitis obliterans was 3% at a median of 12.2 months, and that of cutaneous sclerosis was 8% at a median onset of 14.0 months. Late aGVHD and bronchiolitis obliterans had particularly high nonrelapse mortality of 23% and 32%, respectively, by 2 years after diagnosis. The probability of late aGVHD- and cGVHD-free, relapse-free survival was 38% at 1 year post-HCT and 26% at 2 years post-HCT. This multicenter prospective study confirms the high rate of late aGVHD and cGVHD syndromes and supports the need for continuous close monitoring and development of more effective GVHD treatment strategies to improve HCT success.
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Affiliation(s)
- Mukta Arora
- Division of Hematology, Oncology and Transplant, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Corey S Cutler
- Division of Hematologic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Madan H Jagasia
- Division of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph Pidala
- Blood and Marrow Transplantation Program, Moffitt Cancer Center, Tampa, Florida
| | - Xiaoyu Chai
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - George L Chen
- BMT Program, Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - William A Wood
- Division of Hematology and Oncology, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Jeanne Palmer
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Hien Duong
- Division of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sally Arai
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Sebastian Mayer
- Division of Hematology and Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Iskra Pusic
- Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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25
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Jagasia MH, Basu T, Engelhardt BG, Chen H, Clark W, Waller EK, Giver C, Chen YB, Savani BN, Kassim AA, Jung DK, Polikowsky H, Benmebarek R, Heck S, Ellis R, Seidl T, Mufti G, Irish J, Kordasti S. Single Cell Mass Cytometry Identifies T-Regulatory Cell Subsets Associated with ECP Response in Chronic GVHD. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.928] [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: 11/25/2022]
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26
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Hamilton BK, Rybicki L, Advani AS, Abounader D, Vu K, Romee R, Zeichner SB, Flowers C, Brown S, Bashey A, Viswabandya A, Kim D(DH, Wall S, Devine SM, Sandhu KS, Bachanova V, McGuirk J, Ganguly S, Adekola K, Mehta J, Ueda M, de Lima M, Kennedy V, Jagasia MH, Majhail NS. Allogeneic Hematopoietic Cell Transplantation (HCT) for Adult T-Cell Acute Lymphoblastic Leukemia (T-ALL). Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.591] [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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Arai S, Pidala J, Pusic I, Chai X, Jaglowski S, Khera N, Palmer J, Chen GL, Jagasia MH, Mayer SA, Wood WA, Green M, Hyun TS, Inamoto Y, Storer BE, Miklos DB, Shulman HM, Martin PJ, Sarantopoulos S, Lee SJ, Flowers MED. A Randomized Phase II Crossover Study of Imatinib or Rituximab for Cutaneous Sclerosis after Hematopoietic Cell Transplantation. Clin Cancer Res 2015; 22:319-27. [PMID: 26378033 DOI: 10.1158/1078-0432.ccr-15-1443] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/21/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE Cutaneous sclerosis occurs in 20% of patients with chronic graft-versus-host disease (GVHD) and can compromise mobility and quality of life. EXPERIMENTAL DESIGN We conducted a prospective, multicenter, randomized, two-arm phase II crossover trial of imatinib (200 mg daily) or rituximab (375 mg/m(2) i.v. weekly × 4 doses, repeatable after 3 months) for treatment of cutaneous sclerosis diagnosed within 18 months (NCT01309997). The primary endpoint was significant clinical response (SCR) at 6 months, defined as quantitative improvement in skin sclerosis or joint range of motion. Treatment success was defined as SCR at 6 months without crossover, recurrent malignancy or death. Secondary endpoints included changes of B-cell profiles in blood (BAFF levels and cellular subsets), patient-reported outcomes, and histopathology between responders and nonresponders with each therapy. RESULTS SCR was observed in 9 of 35 [26%; 95% confidence interval (CI); 13%-43%] participants randomized to imatinib and 10 of 37 (27%; 95% CI, 14%-44%) randomized to rituximab. Six (17%; 95% CI, 7%-34%) patients in the imatinib arm and 5 (14%; 95% CI, 5%-29%) in the rituximab arm had treatment success. Higher percentages of activated B cells (CD27(+)) were seen at enrollment in rituximab-treated patients who had treatment success (P = 0.01), but not in imatinib-treated patients. CONCLUSIONS These results support the need for more effective therapies for cutaneous sclerosis and suggest that activated B cells define a subgroup of patients with cutaneous sclerosis who are more likely to respond to rituximab.
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Affiliation(s)
- Sally Arai
- Department of Medicine/Division of Blood and Marrow Transplant, Stanford University School of Medicine, Stanford, California
| | - Joseph Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Iskra Pusic
- Division of Oncology, Section of Bone Marrow Transplantation, Washington University School of Medicine, St. Louis, Missouri
| | - Xiaoyu Chai
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Samantha Jaglowski
- Division of Hematology, Internal Medicine, Ohio State University, Columbus, Ohio
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Jeanne Palmer
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona
| | - George L Chen
- Department of Medicine/Division of Blood and Marrow Transplant, Stanford University School of Medicine, Stanford, California
| | - Madan H Jagasia
- Department of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - William A Wood
- Department of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Michael Green
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Teresa S Hyun
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yoshihiro Inamoto
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Barry E Storer
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David B Miklos
- Department of Medicine/Division of Blood and Marrow Transplant, Stanford University School of Medicine, Stanford, California
| | - Howard M Shulman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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28
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Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, Palmer J, Weisdorf D, Treister NS, Cheng GS, Kerr H, Stratton P, Duarte RF, McDonald GB, Inamoto Y, Vigorito A, Arai S, Datiles MB, Jacobsohn D, Heller T, Kitko CL, Mitchell SA, Martin PJ, Shulman H, Wu RS, Cutler CS, Vogelsang GB, Lee SJ, Pavletic SZ, Flowers MED. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant 2015; 21:389-401.e1. [PMID: 25529383 PMCID: PMC4329079 DOI: 10.1016/j.bbmt.2014.12.001] [Citation(s) in RCA: 1701] [Impact Index Per Article: 189.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 12/01/2014] [Indexed: 12/13/2022]
Abstract
The 2005 National Institutes of Health (NIH) Consensus Conference proposed new criteria for diagnosing and scoring the severity of chronic graft-versus-host disease (GVHD). The 2014 NIH consensus maintains the framework of the prior consensus with further refinement based on new evidence. Revisions have been made to address areas of controversy or confusion, such as the overlap chronic GVHD subcategory and the distinction between active disease and past tissue damage. Diagnostic criteria for involvement of mouth, eyes, genitalia, and lungs have been revised. Categories of chronic GVHD should be defined in ways that indicate prognosis, guide treatment, and define eligibility for clinical trials. Revisions have been made to focus attention on the causes of organ-specific abnormalities. Attribution of organ-specific abnormalities to chronic GVHD has been addressed. This paradigm shift provides greater specificity and more accurately measures the global burden of disease attributed to GVHD, and it will facilitate biomarker association studies.
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Affiliation(s)
- Madan H Jagasia
- Department of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hildegard T Greinix
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Mukta Arora
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kirsten M Williams
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Department of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Daniel Wolff
- Department of Internal Medicine, University of Regensburg, Regensburg, Germany
| | - Edward W Cowen
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeanne Palmer
- Department of Hematology Oncology/Blood and Marrow Transplant, Mayo Clinic Arizona, Phoenix, Arizona
| | - Daniel Weisdorf
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Nathaniel S Treister
- Department of Surgery, Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Guang-Shing Cheng
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Holly Kerr
- Hematology Department, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Pamela Stratton
- Pediatric and Reproductive Endocrinology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Rafael F Duarte
- Department of Hematology, Institut Catala d'Oncologia, Barcelona, Spain
| | - George B McDonald
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Afonso Vigorito
- Hematology and Hemotherapy Center, Hemocentro Unicamp, Campinas, Sao Paulo, Brazil
| | - Sally Arai
- Department of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Manuel B Datiles
- The Eye Clinic, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - David Jacobsohn
- Department of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland
| | - Carrie L Kitko
- Blood and Marrow Transplant Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Sandra A Mitchell
- Department of Applied Research Cancer Control and Population Sciences, National Institutes of Health, Bethesda, Maryland
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Howard Shulman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Roy S Wu
- Cancer Therapy Evaluation Program, National Institutes of Health, Bethesda, Maryland
| | - Corey S Cutler
- Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Georgia B Vogelsang
- Oncology Department, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Steven Z Pavletic
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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Palmer J, Chai X, Martin PJ, Pidala J, Lazaryan A, Arora M, Cutler CS, Pavletic SZ, Pusic I, Jagasia MH, Inamoto Y, Flowers ME, Vogelsang G, Lee SJ. Physician-Reported CR+PR at 6 Months Predicts Subsequent Survival in Patients with Chronic GVHD. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cheng GS, Pusic I, Jagasia MH, Burns LJ, Ho VT, Pidala J, Palmer J, Johnston L, Mayer S, Chai X, Lee SJ, Williams KM. BOS after HCT: Preceding Events, Diagnostic Characteristics, and Natural History of Patients Treated on a Prospective Trial. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.253] [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: 10/24/2022]
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Arora M, Cutler CS, Jagasia MH, Pidala J, Chai X, Martin PJ, Flowers ME, Inamoto Y, Chen GL, Wood B, Khera N, Palmer J, Duong HK, Arai S, Lee SJ. Incidence, Risk Factors, and Prognosis of Late Immune-Mediated Disorders after Allogeneic Hematopoietic Cell Transplantation (HCT). Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khera N, Chai X, Duong HK, Inamoto Y, Chen GL, Mayer S, Arora M, Palmer J, Flowers ME, Cutler CS, Lukez A, Arai S, Lazaryan A, Jagasia MH, Pusic I, Wood W, Lee SJ, Pidala J. Prospective Longitudinal Study of Late Acute Graft Versus Host Disease after Hematopoietic Cell Transplantation: A Report from Chronic GVHD Consortium. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.536] [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: 11/25/2022]
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Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, Palmer J, Weisdorf D, Treister NS, Cheng GS, Kerr H, Stratton P, Duarte RF, McDonald GB, Inamoto Y, Vigorito A, Arai S, Datiles MB, Jacobsohn D, Heller T, Kitko CL, Mitchell SA, Martin PJ, Shulman H, Wu RS, Cutler CS, Vogelsang GB, Lee SJ, Pavletic SZ, Flowers MED. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant 2014. [PMID: 25529383 DOI: 10.1016/j.bbmt.2014.12.001.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The 2005 National Institutes of Health (NIH) Consensus Conference proposed new criteria for diagnosing and scoring the severity of chronic graft-versus-host disease (GVHD). The 2014 NIH consensus maintains the framework of the prior consensus with further refinement based on new evidence. Revisions have been made to address areas of controversy or confusion, such as the overlap chronic GVHD subcategory and the distinction between active disease and past tissue damage. Diagnostic criteria for involvement of mouth, eyes, genitalia, and lungs have been revised. Categories of chronic GVHD should be defined in ways that indicate prognosis, guide treatment, and define eligibility for clinical trials. Revisions have been made to focus attention on the causes of organ-specific abnormalities. Attribution of organ-specific abnormalities to chronic GVHD has been addressed. This paradigm shift provides greater specificity and more accurately measures the global burden of disease attributed to GVHD, and it will facilitate biomarker association studies.
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Affiliation(s)
- Madan H Jagasia
- Department of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hildegard T Greinix
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Mukta Arora
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kirsten M Williams
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Department of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Daniel Wolff
- Department of Internal Medicine, University of Regensburg, Regensburg, Germany
| | - Edward W Cowen
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeanne Palmer
- Department of Hematology Oncology/Blood and Marrow Transplant, Mayo Clinic Arizona, Phoenix, Arizona
| | - Daniel Weisdorf
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Nathaniel S Treister
- Department of Surgery, Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Guang-Shing Cheng
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Holly Kerr
- Hematology Department, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Pamela Stratton
- Pediatric and Reproductive Endocrinology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Rafael F Duarte
- Department of Hematology, Institut Catala d'Oncologia, Barcelona, Spain
| | - George B McDonald
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Afonso Vigorito
- Hematology and Hemotherapy Center, Hemocentro Unicamp, Campinas, Sao Paulo, Brazil
| | - Sally Arai
- Department of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Manuel B Datiles
- The Eye Clinic, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - David Jacobsohn
- Department of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland
| | - Carrie L Kitko
- Blood and Marrow Transplant Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Sandra A Mitchell
- Department of Applied Research Cancer Control and Population Sciences, National Institutes of Health, Bethesda, Maryland
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Howard Shulman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Roy S Wu
- Cancer Therapy Evaluation Program, National Institutes of Health, Bethesda, Maryland
| | - Corey S Cutler
- Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Georgia B Vogelsang
- Oncology Department, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Steven Z Pavletic
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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Boyiadzis M, Arora M, Klein JP, Hassebroek A, Hemmer M, Urbano-Ispizua A, Antin JH, Bolwell BJ, Cahn JYY, Cairo MS, Cutler CS, Flowers ME, Gale RP, Herzig R, Isola LM, Jacobsohn DA, Jagasia MH, Klumpp TR, Lee SJ, Petersdorf EW, Santarone S, Spellman SR, Schouten HC, Verdonck LF, Wingard JR, Weisdorf DJ, Horowitz MM, Pavletic SZ. Impact of Chronic Graft-versus-Host Disease on Late Relapse and Survival on 7,489 Patients after Myeloablative Allogeneic Hematopoietic Cell Transplantation for Leukemia. Clin Cancer Res 2014; 21:2020-8. [PMID: 25348512 DOI: 10.1158/1078-0432.ccr-14-0586] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 09/21/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE Malignancy relapse remains a major obstacle for successful allogeneic hematopoietic cell transplantation (HCT). Chronic graft-versus-host disease (cGVHD) is associated with fewer relapses. However, when studying effects of cGVHD on relapse, it is difficult to separate from acute GVHD effects as most cases of cGVHD occur within the first year after transplant at the time when acute GVHD is still active. EXPERIMENTAL DESIGN This study based on CIBMTR registry data investigated cGVHD and its association with the incidence of late relapse and survival in 7,489 patients with acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), and myelodysplastic syndromes (MDS), who were leukemia free at 12 months after myeloablative allogeneic HCT. RESULTS Forty-seven percent of the study population was diagnosed with cGVHD at 12 months after transplant. The protective effect of cGVHD on late relapse was present only in patients with CML [RR, 0.47; 95% confidence interval (CI), 0.37-0.59; P < 0.0001). cGVHD was significantly associated with higher risk of treatment-related mortality (TRM; RR, 2.43; 95% CI, 2.09-2.82; P < 0.0001) and inferior overall survival (RR, 1.56; 95% CI, 1.41-1.73; P < 0.0001) for all diseases. In patients with CML, all organ sites and presentation types of cGVHD were equally associated with lower risk of late relapse. CONCLUSIONS These results indicate that clinically relevant antileukemia effects of cGVHD on late relapses are present only in CML but not in AML, ALL, or MDS. Chronic GVHD in patients who are 1-year survivors after myeloablative allogeneic HCT is primarily associated with higher TRM and inferior survival.
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Affiliation(s)
- Michael Boyiadzis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Mukta Arora
- University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - John P Klein
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anna Hassebroek
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Michael Hemmer
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | | | | | | | - Mary E Flowers
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Roger Herzig
- University of Louisville Hospital/James Brown Cancer Center, Louisville, Kentucky
| | | | | | | | - Thomas R Klumpp
- Temple Bone Marrow Transplant Program, Philadelphia, Pennsylvania
| | | | | | | | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | | | - John R Wingard
- Shands HealthCare and University of Florida, Gainesville, Florida
| | - Daniel J Weisdorf
- University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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McClune BL, Ahn KW, Wang HL, Antin JH, Artz AS, Cahn JY, Deol A, Freytes CO, Hamadani M, Holmberg LA, Jagasia MH, Jakubowski AA, Kharfan-Dabaja MA, Lazarus HM, Miller AM, Olsson R, Pedersen TL, Pidala J, Pulsipher MA, Rowe JM, Saber W, van Besien KW, Waller EK, Aljurf MD, Akpek G, Bacher U, Chao NJ, Chen YB, Cooper BW, Dehn J, de Lima MJ, Hsu JW, Lewis ID, Marks DI, McGuirk J, Cairo MS, Schouten HC, Szer J, Ramanathan M, Savani BN, Seftel M, Socie G, Vij R, Warlick ED, Weisdorf DJ. Allotransplantation for patients age ≥40 years with non-Hodgkin lymphoma: encouraging progression-free survival. Biol Blood Marrow Transplant 2014; 20:960-8. [PMID: 24641829 DOI: 10.1016/j.bbmt.2014.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 01/30/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
Non-Hodgkin lymphoma (NHL) disproportionately affects older patients, who do not often undergo allogeneic hematopoietic cell transplantation (HCT). We analyzed Center for International Blood and Marrow Transplant Research data on 1248 patients age ≥40 years receiving reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT for aggressive (n = 668) or indolent (n = 580) NHL. Aggressive lymphoma was more frequent in the oldest cohort 49% for age 40 to 54 versus 57% for age 55 to 64 versus 67% for age ≥65; P = .0008). Fewer patients aged ≥65 had previous autografting (26% versus 24% versus 9%; P = .002). Rates of relapse, acute and chronic GVHD, and nonrelapse mortality (NRM) at 1 year post-HCT were similar in the 3 age cohorts (22% [95% confidence interval (CI), 19% to 26%] for age 40 to 54, 27% [95% CI, 23% to 31%] for age 55 to 64, and 34% [95% CI, 24% to 44%] for age ≥65. Progression-free survival (PFS) and overall survival (OS) at 3 years was slightly lower in the older cohorts (OS: 54% [95% CI, 50% to 58%] for age 40 to 54; 40% [95% CI, 36% to 44%] for age 55 to 64, and 39% [95% CI, 28% to 50%] for age ≥65; P < .0001). Multivariate analysis revealed no significant effect of age on the incidence of acute or chronic GVHD or relapse. Age ≥55 years, Karnofsky Performance Status <80, and HLA mismatch adversely affected NRM, PFS, and OS. Disease status at HCT, but not histological subtype, was associated with worse NRM, relapse, PFS, and OS. Even for patients age ≥55 years, OS still approached 40% at 3 years, suggesting that HCT affects long-term remission and remains underused in qualified older patients with NHL.
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Affiliation(s)
- Brian L McClune
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Kwang Woo Ahn
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hai-Lin Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joseph H Antin
- Division of Hematologic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andrew S Artz
- Section of Hematology/Oncology, University of Chicago School of Medicine, Chicago, Illinois
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Abhinav Deol
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - César O Freytes
- Department of Hematology, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Madan H Jagasia
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Ann A Jakubowski
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Alan M Miller
- Department of Oncology, Baylor University Medical Center, Dallas, TX
| | - Richard Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Tanya L Pedersen
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL
| | - Michael A Pulsipher
- Primary Children's Hospital, Division of Hematology/Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jacob M Rowe
- Department of Hematology, Rambam Medical Center, Haifa, Israel
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Edmund K Waller
- Bone Marrow and Stem Cell Transplant Center, Winship Cancer Institute, Emory University Hospital, Atlanta, Georgia
| | - Mahmoud D Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | - Görgun Akpek
- Banner M.D. Anderson Cancer Center, Gilbert, Arizona
| | - Ulrike Bacher
- Department of Stem Cell Transplantation, University of Hamburg, Hamburg, Germany; MLL Munich Leukemia Laboratory, Munich, Germany
| | - Nelson J Chao
- Division of Cell Therapy, Duke University Medical Center, Durham, NC
| | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Brenda W Cooper
- Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH
| | - Jason Dehn
- National Marrow Donor Program, Minneapolis, MN
| | - Marcos J de Lima
- Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH
| | - Jack W Hsu
- Division of Hematology/Oncology, Shands HealthCare, University of Florida, Gainesville, FL
| | - Ian D Lewis
- Haematology Clinical Trial Office, Royal Adelaide Hospital/SA Pathology, Adelaide, Australia
| | - David I Marks
- Avon Haematology Unit and BCH BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom
| | - Joseph McGuirk
- Division of Hematology & Oncology, University of Kansas, Westwood, KS
| | - Mitchell S Cairo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY
| | - Harry C Schouten
- Division of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - Jeffrey Szer
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital City Campus, Victoria, Australia
| | - Muthalagu Ramanathan
- Department of Hematologic Malignancies Bone Marrow Transplant, UMass Memorial Medical Center, Worcester, MA
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gérard Socie
- Department of Hematology, Hopital Saint Louis, Paris, France
| | - Ravi Vij
- Division of Medical Oncology, Barnes Jewish Hospital, St. Louis Children's Hospital, Washington University, St. Louis, MO
| | - Erica D Warlick
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Daniel J Weisdorf
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota.
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Engelhardt BG, Jung DK, Savani BN, Jagasia MH, Kassim AA, Sengsayadeth S, Yoder S, Rock M, Crowe JE. Early Th1 Immunity Decreases Acute Graft-Versus-Host Disease and Impairs Graft-Versus-Leukemia Effect after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.053] [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: 10/25/2022]
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Jagasia MH, Chai X, Pidala J, Inamoto Y, Arora M, Cutler CS, Flowers ME, Johnston L, Pavletic SZ, Lee SJ. Ocular Gvhd: Epidemiology, Risk Factors and Impact on Quality of Life-a Chronic Gvhd Consortium Study. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.453] [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: 11/25/2022]
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Gupta V, Malone AK, Hari PN, Ahn KW, Hu ZH, Gale RP, Ballen KK, Hamadani M, Olavarria E, Gerds AT, Waller EK, Costa LJ, Antin JH, Kamble RT, van Besien KM, Savani BN, Schouten HC, Szer J, Cahn JY, de Lima MJ, Wirk B, Aljurf MD, Popat U, Bejanyan N, Litzow MR, Norkin M, Lewis ID, Hale GA, Woolfrey AE, Miller AM, Ustun C, Jagasia MH, Lill M, Maziarz RT, Cortes J, Kalaycio ME, Saber W. Reduced-intensity hematopoietic cell transplantation for patients with primary myelofibrosis: a cohort analysis from the center for international blood and marrow transplant research. Biol Blood Marrow Transplant 2014; 20:89-97. [PMID: 24161923 PMCID: PMC3886623 DOI: 10.1016/j.bbmt.2013.10.018] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
Abstract
We evaluated outcomes and associated prognostic factors in 233 patients undergoing allogeneic hematopoietic cell transplantation (HCT) for primary myelofibrosis (MF) using reduced-intensity conditioning (RIC). The median age at RIC HCT was 55 yr. Donors were a matched sibling donor (MSD) in 34% of RIC HCTs, an HLA well-matched unrelated donor (URD) in 45%, and a partially matched/mismatched URD in 21%. Risk stratification according to the Dynamic International Prognostic Scoring System (DIPSS) was 12% low, 49% intermediate-1, 37% intermediate-2, and 1% high. The probability of survival at 5 yr was 47% (95% confidence interval [CI], 40% to 53%). In a multivariate analysis, donor type was the sole independent factor associated with survival. Adjusted probabilities of survival at 5-yr were 56% (95% CI, 44% to 67%) for MSD, 48% (95% CI, 37% to 58%) for well-matched URD, and 34% (95% CI, 21% to 47%) for partially matched/mismatched URD (P = .002). The relative risk (RR) for NRM was 3.92 (P = .006) for well-matched URD and 9.37 (P < .0001) for partially matched/mismatched URD. Trends toward increased NRM (RR, 1.7; P = .07) and inferior survival (RR, 1.37; P = .10) were observed in DIPSS intermediate-2/high-risk patients compared with DIPSS low/intermediate-1 risk patients. Our data indicate that RIC HCT is a potentially curative option for patients with MF, and that donor type is the most important factor influencing survival in these patients.
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Affiliation(s)
- Vikas Gupta
- Princess Margaret Cancer Center, University of Toronto, Toronto, Canada.
| | | | - Parameswaran N Hari
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhen-Huan Hu
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert Peter Gale
- Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, UK
| | | | - Mehdi Hamadani
- West Virginia University Hospitals, Morgantown, West Virginia
| | - Eduardo Olavarria
- Hematology Department and BMT Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Aaron T Gerds
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edmund K Waller
- Bone Marrow and Stem Cell Transplant Center, Emory University Hospital, Atlanta, Georgia
| | - Luciano J Costa
- Blood and Marrow Transplant Program, Medical University of South Carolina, Charleston, South Carolina
| | | | - Rammurti T Kamble
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Koen M van Besien
- Stem Cell Transplant Program, Weill Cornell Medical College, New York, New York
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jeffrey Szer
- Clinical Haematology and BMT Service, Royal Melbourne Hospital, Victoria, Australia
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Marcos J de Lima
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Baldeep Wirk
- Department of Hematology/Oncology, Shands HealthCare and University of Florida, Gainesville, Florida
| | - Mahmoud D Aljurf
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Uday Popat
- Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas
| | - Nelli Bejanyan
- Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical Center, Minneapolis, Minnesota
| | | | - Maxim Norkin
- Department of Hematology/Oncology, Shands HealthCare and University of Florida, Gainesville, Florida
| | - Ian D Lewis
- Haematology and Bone Marrow Transplant Unit, Royal Adelaide Hospital/SA Pathology, Adelaide, Australia
| | | | - Ann E Woolfrey
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Celalettin Ustun
- Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical Center, Minneapolis, Minnesota
| | | | - Michael Lill
- Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Richard T Maziarz
- Center for Hematologic Malignancies, Oregon Health and Science University, Portland, Oregon
| | - Jorge Cortes
- Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas
| | | | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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Seegmiller AC, Kim AS, Mosse CA, Levy MA, Thompson MA, Kressin MK, Jagasia MH, Strickland SA, Reddy NM, Marx ER, Sinkfield KJ, Pollard HN, Plummer WD, Dupont WD, Shultz EK, Dittus RS, Stead WW, Santoro SA, Zutter MM. Optimizing personalized bone marrow testing using an evidence-based, interdisciplinary team approach. Am J Clin Pathol 2013; 140:643-50. [PMID: 24124142 DOI: 10.1309/ajcp8cke9neinqfl] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To address the overuse of testing that complicates patient care, diminishes quality, and increases costs by implementing the diagnostic management team, a multidisciplinary system for the development and deployment of diagnostic testing guidelines for hematologic malignancies. METHODS The team created evidence-based standard ordering protocols (SOPs) for cytogenetic and molecular testing that were applied by pathologists to bone marrow biopsy specimens on adult patients. Testing on 780 biopsy specimens performed during the six months before SOP implementation was compared with 1,806 biopsy specimens performed during the subsequent 12 months. RESULTS After implementation, there were significant decreases in tests discordant with SOPs, omitted tests, and the estimated cost of testing to payers. The fraction of positive tests increased. Clinicians reported acceptance of the new procedures and perceived time savings. CONCLUSIONS This process is a model for optimizing complex and personalized diagnostic testing.
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Affiliation(s)
- Adam C. Seegmiller
- Departments of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - Annette S. Kim
- Departments of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - Claudio A. Mosse
- Departments of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
- Department of Pathology and Laboratory Medicine, VA Tennessee Valley Healthcare System, Nashville, TN
| | - Mia A. Levy
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Mary Ann Thompson
- Departments of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - Megan K. Kressin
- Departments of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
- Department of Pathology and Laboratory Medicine, VA Tennessee Valley Healthcare System, Nashville, TN
| | - Madan H. Jagasia
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Nishitha M. Reddy
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Edward R. Marx
- Office of the Vice Chancellor for Health Affairs, Vanderbilt University School of Medicine, Nashville, TN
| | - Kristy J. Sinkfield
- Office of Strategy and Transformation, Vanderbilt University School of Medicine, Nashville, TN
| | - Herschel N. Pollard
- Office of Strategy and Transformation, Vanderbilt University School of Medicine, Nashville, TN
| | - W. Dale Plummer
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - William D. Dupont
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Edward K. Shultz
- Departments of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
| | - Robert S. Dittus
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Institute for Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN
- Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
| | - William W. Stead
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
- Office of Strategy and Transformation, Vanderbilt University School of Medicine, Nashville, TN
| | - Samuel A. Santoro
- Departments of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - Mary M. Zutter
- Departments of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
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Reddy NM, Oluwole O, Greer JP, Engelhardt BG, Jagasia MH, Savani BN. Outcomes of autologous or allogeneic stem cell transplantation for non-Hodgkin lymphoma. Exp Hematol 2013; 42:39-45. [PMID: 24096123 DOI: 10.1016/j.exphem.2013.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 08/26/2013] [Accepted: 09/23/2013] [Indexed: 11/25/2022]
Abstract
Transplant outcomes of autologous or allogeneic stem cell transplantation (SCT) have not been elucidated as a single cohort in non-Hodgkin lymphoma (NHL). We analyzed the outcomes of 270 adult recipients receiving autologous (auto) SCT (n = 198) or allogeneic (allo) SCT (n = 72) for NHL between the years 2000 and 2010. Five-year overall survival rates for B and T cell NHL were 58% and 50%, respectively (allo-SCT 51% vs. 54% for B and T-cell NHL, and auto-SCT 60% vs. 47% for B and T cell lymphoma, respectively). In multivariate analysis, the number of chemotherapy regimens and disease status pre-SCT were independently associated with long-term outcome after SCT (for both auto- and allo-SCT). We conclude that the type of transplantation offered to patients, based on patient selection and disease-related factors, can achieve long-term survival, highlighting the importance of further improvement in disease control and reducing procedure-related mortality. The role of transplantation needs to be reevaluated in the era of targeted therapy.
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Affiliation(s)
- Nishitha M Reddy
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Olalekan Oluwole
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John P Greer
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian G Engelhardt
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madan H Jagasia
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bipin N Savani
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Kassim A, McDuffie JS, Mosse CA, Savani BN, Greer JP, Oluwole OO, Goodman S, Engelhardt BG, Chinratanalab W, Kim AS, Jagasia MH. Minimal residual disease (MRD) status pre- and post- high-dose therapy/autologous stem (HDC/ASCT) cell transplantation for multiple myeloma (MM) in the era of novel agents. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.8605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8605 Background: MRD assayed by multi-parameter flow cytometer (MFC), has prognostic significance after HDT/ASCT for MM (Paiva et. al. 2008). The frequency of MRD negativity (-) after induction therapy using novel agents such as immunomodulatory drugs like lenalidomide (IMiDs), and proteasome inhibitors like bortezomib, is unknown. The impact of HDT/ASCT on MRD status in this patient group has not been studied. Methods: We performed a retrospective study of all MM patients undergoing HDT/ASCT (January 2010 - December 2012) in our institution. No restrictions on inclusion were made based on the International Myeloma Working Group response criteria. All patients had novel agents as part of their initial induction regimen. Statistical analysis was by SPSS software (V 12.0). MRD status was determined by MFC on bone marrow samples pre- HDC/ASCT [M1] and post- HDC/ASCT (D100 [M2] and I year [M3]). MFC was done with antibodies against CD45, CD19, CD138, CD38, CD20, CD56, and anti-k and l cytoplasmic antibodies. Results: MRD status was available on 91 patients pre-transplant. Of these patients, 80 had MFC recorded at M2 and 17 patients had MFC recorded at M3. Fifty-eight percent were male and 76% were Caucasian. Forty percent received IMiDs, while 60% got proteasome based therapies. Of the 91 patients with MRD pre-HDC/ASCT, 58% (53/91) were MRD (-), and of these patients 89% (41/46) remained MRD (-) at M2. 48 patients were MRD positive (+) pre-HDC/ASCT, 58% (20/34) became MRD (-) at M2. Age, cytogenetic risk, disease stage, number of chemotherapy cycles or immunofixation status had no impact on MRD status. There were only 6 relapses in the cohort, thus the impact of MRD status on progression-free survival could not be studied. Conclusions: Novel agents improve depth of response pre-transplant. HDC/ASCT increases MRD negativity post-transplant. MRD status could aid better timing of HDC/ASCT or adoption of a risk-adapted strategy for high-risk patients. MRD status validation in a prospective cohort is underway at our center (NCT01215344). With future follow-up, the impact of MRD on progression-free survival in the era of novel agents will be determined.
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McDuffie JS, Savani BN, Chinratanalab W, Goodman S, Greer JP, Oluwole OO, Engelhardt BG, Jagasia MH, Kassim A. Early lymphocyte recovery (ELR) impact on disease outcome following autologous hematopoietic stem cell transplantation (HDT/ASCT) for multiple myeloma (MM) in the era of novel agents. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e19539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19539 Background: Absolute lymphocyte count (ALC) > 500 cells/ µL on day 15 (ELR+) after HDT/ASCT, has been reported to be an independent prognostic indicator, for improved OS and PFS in patients with MM. Novel agents (immunomodulatory drugs (IMiDs) and proteasome inhibitors), mediate there effect through T-cell stimulation, NK cell activation, anti-proliferation, and are now main stay of therapy for MM. We sought to determine their effects on ELR, and correlated to disease outcome. Methods: A retrospective review of all MM patients seen at our institution undergoing HDT/ASCT from January 2008 to December 2012 was performed. Patients were identified from our CIBMTR database. ALC was determined pre-HDT/ASCT (T1), on day15 (T2) and d30 (T3) post-HDC/ASCT. No restrictions on inclusion were made based upon the International Myeloma Working Group response criteria. All had novel agents as part of their initial induction regimen. Disease response was determined by standard clinical and laboratory CIBMTR response criteria, and minimal residual disease status (MRD) by multiparameter flow cytometry. Results: In our study (n= 184), 52/184 patients had ELR+ while 132/184 had ALC < 500 cells/mL (ELR-) at T2. 21% received IMiDs, 33% proteasome inhibitor and 46% combination therapies. 52% of the ELR+ patients were MRD negative (-) at T1, and improved to 74% and 89% at D100, and 1 year post-HDC/ASCT respectively. Similarly 63%, 70%, and 80% of the ELR- patients, were MRD (-) at similar time-points. Chi squared analysis showed no significant difference in rates of MRD (-) based on ELR. ELR also had no impact on disease status as determined by CIBMTR response criteria, or 1 year PFS and OS (p = 0.383), (p = 0.577) respectively. Multivariate analyses, using cox-regression showed no impact of ALC at T1, T2, T3, age, sex, race, cytogenetic risk, or disease stage on disease outcome. Conclusions: Novel agents improve disease control independent of ELR following HDC/ASCT. Understanding their biologic effect on immune-reconstitution will provide a platform for adoptive immunotherapy to better target minimal residual disease.
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Reddy N, Oluwole O, Greer JP, Goodman S, Engelhardt B, Jagasia MH, Savani BN. Superior long-term outcome of patients with early transformation of non-Hodgkin lymphoma undergoing stem cell transplantation. Clin Lymphoma Myeloma Leuk 2012; 12:406-11. [PMID: 22981964 DOI: 10.1016/j.clml.2012.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 07/17/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED In this study, we discuss the results of patients with transformed lymphoma (TL) undergoing stem cell transplantation (SCT). Because of the paucity of literature on the treatment of TL, deciding on the optimal evidence-based treatment is a challenge. Herein, our results indicate that patients with early transformation may benefit the most from SCT. BACKGROUND Transformed non-Hodgkin's lymphoma arising from follicular lymphoma (TL) carries a poor prognosis with a median survival time after transformation reported to be approximately 1 year. PATIENTS AND METHODS Fifty-one consecutive patients with TL received SCT between January 2000 and December 2010 (autologous SCT, n = 44, allogeneic SCT, n = 7). RESULTS Thirty-six (70.5%) patients had an early transformation, defined as histologic evidence of transformation at the time of initial diagnosis or transformation within 1 year of follicular lymphoma. Fifteen patients had early stage disease (29%) and 36 (71%) had advanced stage disease on presentation. At the time of analysis, 37 patients were alive with an estimated 5-year overall survival (OS) and event free survival (EFS) of 61.8% and 45%, respectively. OS and EFS were not significantly different between types of transplant procedure. The major cause of transplant failure was disease recurrence, with estimated 2-year relapse rate of 37.4%. Importantly, early transformation was independently associated with improved OS (hazard ratio [HR] 3.29; P = .028) and EFS (HR 2.49; P = .029). CONCLUSION Our results indicate that an aggressive transplant approach should be considered first in patients with TL and emphasize the need to incorporate novel strategies (eg, immunomodulation) early post-SCT to prevent relapses as disease recurrence remains the major cause of failure in heavily pretreated patients.
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Affiliation(s)
- Nishitha Reddy
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Abstract
As survival rates continue to increase after allogeneic stem cell transplant (allo-SCT), the associated long-term complications of transplant need to be taken into consideration. Here, we review the endocrine and metabolic complications associated with transplant survivors, including diabetes, dyslipidemia, hypertension, cardiovascular disease, hypogonadism, vitamin D deficiency, osteoporosis, thyroid disease, adrenal dysfunction, and pituitary disorders, and provide a brief summary of evaluation and treatment of these conditions.
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Affiliation(s)
- Uma Gunasekaran
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-8148, USA
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Hart AJ, Jagasia MH, Kim AS, Mosse CA, Savani BN, Kassim A. Minimal residual disease in myeloma: are we there yet? Biol Blood Marrow Transplant 2012; 18:1790-9. [PMID: 22626785 DOI: 10.1016/j.bbmt.2012.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/03/2012] [Indexed: 12/20/2022]
Abstract
Measurement of minimal residual disease is routine in diseases such as chronic myelogenous leukemia, precursor B cell acute lymphoblastic leukemia, and acute promyelocytic leukemia because it provides important prognostic information. However, the role of minimal residual disease testing has not been widely adopted in multiple myeloma (MM), with other parameters such as the International Staging System (ISS) and cytogenetic analysis primarily guiding therapy and determination of prognosis. Until recently, achieving a complete response (CR), as defined by the International Myeloma Working Group (IMWG) criteria, was rare in patients with MM. The use of novel agents with or without autologous peripheral blood stem cell transplantation (auto-PBSCT) has significantly increased CR rates, thus increasing overall survival (OS) rates. The majority of patients with MM have persistent levels of residual disease that are below the sensitivity of bone marrow (BM) morphology, protein electrophoresis with immunofixation, and light chain quantitation even after attaining CR and will eventually relapse. Measurement of minimal residual disease by more sensitive methods, and the use of these methods as a tool for predicting patient outcomes and guiding therapeutic decisions, has thus become more relevant. Methods available for monitoring minimal residual disease in MM include PCR and multiparameter flow cytometry (MFC), both of which have been shown to be valuable in other hematologic malignancies; however, neither has become a standard of care in MM. Here, we review current evidence for using minimal residual disease measurement for risk assessment in MM as well as incorporating pretreatment factors and posttreatment minimal residual disease monitoring as a prognostic tool for therapeutic decisions, and we outline challenges to developing uniform criteria for minimal residual disease monitoring.
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Affiliation(s)
- Andrew J Hart
- Department of Medicine, Division of Hematology/Oncology, Section of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Reddy N, Greer JP, Goodman S, Kassim A, Morgan DS, Chinratanalab W, Brandt S, Englehardt B, Oluwole O, Jagasia MH, Savani BN. Consolidative therapy with stem cell transplantation improves survival of patients with mantle cell lymphoma after any induction regimen. Exp Hematol 2012; 40:359-66. [PMID: 22269117 DOI: 10.1016/j.exphem.2012.01.012] [Citation(s) in RCA: 5] [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: 09/29/2011] [Revised: 12/13/2011] [Accepted: 01/04/2012] [Indexed: 10/14/2022]
Abstract
Intensive induction regimen followed by high-dose chemotherapy and autologous stem cell transplantation (auto-SCT) is frequently used to improve outcomes in patients with mantle-cell lymphoma. The comparative impact of conventional vs intensive induction regimen before transplantation is unknown. Forty-eight patients with mantle-cell lymphoma receiving SCT at our institution between January 2000 and December 2010 were included in this study. At the time of initial presentation, 43 (89.5%) had stage IV disease and 18 (37.5%) received more than one chemotherapy regimen before transplantation. Forty patients underwent auto-SCT and 7 had allogeneic SCT (allo-SCT); 1 patient had an allo-SCT for relapsed disease after auto-SCT. At the time of this analysis (median follow-up of 6 years from diagnosis and 4 years from transplantation), 40 patients (88%) were alive with a 5-year disease-free survival of 74.8%. Age, disease stage, number of regimens pre-SCT, pre-SCT disease status, and type of SCT had no impact on long-term outcomes. Importantly, there were no differences among the types of induction regimen on outcomes in this cohort receiving SCT. Based on our data, we believe that future studies should focus on strategies to prevent disease relapse rather than comparing induction regimens before stem cell transplantation.
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Affiliation(s)
- Nishitha Reddy
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Inamoto Y, Chai X, Kurland BF, Cutler C, Flowers MED, Palmer JM, Carpenter PA, Heffernan MJ, Jacobsohn D, Jagasia MH, Pidala J, Khera N, Vogelsang GB, Weisdorf D, Martin PJ, Pavletic SZ, Lee SJ. Validation of measurement scales in ocular graft-versus-host disease. Ophthalmology 2011; 119:487-93. [PMID: 22153706 DOI: 10.1016/j.ophtha.2011.08.040] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To validate measurement scales for rating ocular chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation. Candidate scales were recommended for use in clinical trials by the National Institutes of Health (NIH) Chronic GVHD Consensus Conference or have been previously validated in dry eye syndromes. DESIGN Prospective follow-up study. PARTICIPANTS Between August 2007 and June 2010, the study enrolled 387 patients with chronic GVHD in a multicenter, prospective, observational cohort. METHODS Using anchor-based methods, we compared clinician or patient-reported changes in eye symptoms (8-point scale) with calculated changes in 5 candidate scales: The NIH eye score, patient-reported global rating of eye symptoms, Lee eye subscale, Ocular Surface Disease Index, and Schirmer test. Change was examined for 333 follow-up visits where both clinician and patient reported eye involvement at the previous visit. Linear mixed models were used to account for within-patient correlation. MAIN OUTCOME MEASURES An 8-point scale of clinician or patient-reported symptom change was used as an anchor to measure symptom changes at the follow-up visits. RESULTS In serial evaluations, agreement regarding improvement, stability, or worsening between the clinician and patient was fair (weighted kappa = 0.34). Despite only fair agreement between evaluators, all scales except the Schirmer test correlated with both clinician-reported and patient-reported changes in ocular GVHD activity. Among all scales, changes in the NIH eye scores showed the greatest sensitivity to symptom change reported by clinicians or patients. CONCLUSIONS Our results support the use of the NIH eye score as a sensitive measure of eye symptom changes in clinical trials assessing treatment of chronic GVHD.
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Affiliation(s)
- Yoshihiro Inamoto
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA
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McClintock-Treep SA, Briggs RC, Shults KE, Flye-Blakemore LA, Mosse CA, Jagasia MH, Shinar AA, Dupont WD, Stelzer GT, Head DR. Quantitative assessment of myeloid nuclear differentiation antigen distinguishes myelodysplastic syndrome from normal bone marrow. Am J Clin Pathol 2011; 135:380-5. [PMID: 21350091 DOI: 10.1309/ajcp00shtqcvuyri] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
By using flow cytometry, we analyzed myeloid nuclear differentiation antigen (MNDA) expression in myeloid precursors in bone marrow from patients with myelodysplastic syndrome (MDS) and control samples from patients undergoing orthopedic procedures. The median percentage of MNDA-dim myeloid precursors in MDS cases was 67.4% (range, 0.7%-97.5%; interquartile range, 44.9%-82.7%) of myeloid cells, with bimodal MNDA expression in most MDS samples. Control samples demonstrated a median MNDA-dim percentage in myeloid precursors of 1.2% (range, 0.2%-13.7%; interquartile range, 0.6%-2.7%), with no bimodal pattern in most samples. The area under the receiver operating characteristic curve for MNDA-dim percentage in myeloid precursors was 0.96 (P = 9 × 10(-7)). Correlation of MNDA-dim levels with World Health Organization 2008 morphologic diagnoses was not significant (P = .21), but correlation with patient International Prognostic Scoring System scores suggested a trend (P = .07). Flow cytometric assessment of MNDA in myeloid precursors in bone marrow may be useful for the diagnosis of MDS.
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Affiliation(s)
| | - Robert C. Briggs
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Keith E. Shults
- Esoterix, Center for Innovation, Brentwood, TN
- Nodality, Franklin, TN
| | | | - Claudio A. Mosse
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
- Tennessee Valley Healthcare Systems Veterans Administration, Nashville, TN
| | - Madan H. Jagasia
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew A. Shinar
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, TN
| | - William D. Dupont
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Greg T. Stelzer
- Esoterix, Center for Innovation, Brentwood, TN
- Nodality, Franklin, TN
| | - David R. Head
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
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Griffith ML, Jagasia MH, Misfeldt AA, Chen H, Engelhardt BG, Kassim A, Savani BN, Survant M, Jagasia SM. Pretransplantation C-Peptide Level Predicts Early Posttransplantation Diabetes Mellitus and Has an Impact on Survival after Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2011; 17:86-92. [DOI: 10.1016/j.bbmt.2010.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 06/08/2010] [Indexed: 12/13/2022]
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50
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Jagasia MH, Savani BN, Neff A, Dixon S, Chen H, Pickard AS. Outcome, toxicity profile and cost analysis of autologous stem cell mobilization. Bone Marrow Transplant 2010; 46:1084-8. [DOI: 10.1038/bmt.2010.254] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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