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Bansal R, Vergidis P, Tosh PK, Wilson J, Hathcock M, Khurana A, Bennani NN, Paludo J, Villasboas JC, Wang Y, Ansell SM, Johnston PB, Freeman C, Lin Y. Serial Evaluation of Preimmunization Antibody Titers in Lymphoma Patients Receiving Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2024; 30:455.e1-455.e7. [PMID: 38346643 DOI: 10.1016/j.jtct.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/02/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
Antibody titers and the potential need for immunization have not been formally studied in recipients of chimeric antigen receptor T cell therapy (CAR-T). Prior studies have shown that CD19-targeted CAR-T can induce persistent B cell aplasia but preserve plasma cells for humoral response. Aiming to assess the immune repertoire and antibody titer status of CAR-T recipients, we conducted a retrospective study of immune cell recovery and antibody titers to vaccines in anti-CD19 CAR-T recipients at Mayo Clinic, Rochester. In our cohort of 95 CAR-T recipients, almost one-half had low CD4 T and B cell counts prior to CAR-T that remained persistently low post-CAR-T. Prior to CAR-T, the seronegative rate was lowest for tetanus and highest for pneumococcus irrespective of prior transplantation status (within 2 years of CAR-T). At 3 months post-CAR-T, overall seronegativity rates were similar to pre-CAR-T rates for the prior transplantation and no prior transplantation groups. For patients who received IVIG, loss of seropositivity was seen for hepatitis A (1 of 7; 14%). No seroconversion was noted for pneumococcus. For patients who did not receive IVIG, loss of seropositivity was seen for pneumococcus (2 of 5; 40%) and hepatitis A (1 of 4; 25%). CAR-T recipients commonly experience T cell and B cell lymphopenia and might not have adequate antibody titers against vaccine-preventable diseases despite IVIG supplementation. Loss of antibody titers post-CAR-T is possible, highlighting the need for revaccination. Additional studies with long-term follow-up are needed to inform the optimal timing of immunization post-CAR-T.
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Affiliation(s)
- Radhika Bansal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Pritish K Tosh
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - John Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Arushi Khurana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - N Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Catherine Freeman
- Division of Asthma, Allergy and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota.
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2
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Wiedmeier-Nutor JE, Iqbal M, Rosenthal AC, Bezerra ED, Garcia-Robledo JE, Bansal R, Johnston PB, Hathcock M, Larsen JT, Bergsagel PL, Wang Y, Reeder CB, Leis JF, Fonseca R, Palmer JM, Gysbers BJ, Mwangi R, Warsame RM, Kourelis T, Hayman SR, Dingli D, Kapoor P, Kumar SK, Durani U, Villasboas JC, Paludo J, Bennani NN, Nowakowski G, Ansell SM, Castro JE, Kharfan-Dabaja MA, Lin Y, Vergidis P, Murthy HS, Munoz J. Response to COVID-19 vaccination post CAR T therapy in patients with non-Hodgkin lymphoma and multiple myeloma. Clinical Lymphoma Myeloma and Leukemia 2023; 23:456-462. [PMID: 37003846 PMCID: PMC9990888 DOI: 10.1016/j.clml.2023.03.002] [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] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
COVID-19 adversely affects individuals with cancer. Several studies have found that seroconversion rates among patients with hematologic malignancies are suboptimal when compared to patients without cancer. Patients with non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) are immunocompromised due to impaired humoral and cellular immunity in addition to prescribed immunosuppressive therapy. Chimeric antigen receptor T-cell (CAR T) therapy is now widely used for NHL and MM, but little is known about seroconversion rates after COVID-19 vaccination among these populations. We evaluated SARS-CoV-2 spike-binding IgG antibody levels following COVID-19 vaccination among NHL and MM CAR T therapy recipients. Out of 104 CAR T infusions, 19 patients developed known COVID-19 infection post-CAR T. We tested 17 patients that received CAR T for antibody spike titers post COVID-19 vaccination, only 29 % (n = 5) were able to mount a clinically relevant antibody response (>250 IU/mL).
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Affiliation(s)
| | - Madiha Iqbal
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | - Jeremy T Larsen
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - P Leif Bergsagel
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Craig B Reeder
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Jose F Leis
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Rafael Fonseca
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Jeanne M Palmer
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Brianna J Gysbers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Raphael Mwangi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Urshila Durani
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Januario E Castro
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Hemant S Murthy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Javier Munoz
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
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3
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Acosta-Medina AA, Johnson IM, Bansal R, Hathcock M, Kenderian SJ, Durani U, Khurana A, Wang Y, Paludo J, Villasboas JC, Bennani NN, Johnston PB, Ansell SM, Lin Y, Alkhateeb HB. Pre-lymphodepletion & infusion endothelial activation and stress index as predictors of clinical outcomes in CAR-T therapy for B-cell lymphoma. Blood Cancer J 2023; 13:7. [PMID: 36599834 DOI: 10.1038/s41408-022-00777-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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4
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Bansal R, Baksh M, Larsen JT, Hathcock M, Dingli D, Stewart K, Kapoor P, Kourelis T, Hayman SR, Warsame RM, Fonseca R, Bergsagel PL, Ailawadhi S, Kumar S, Lin Y. Prognostic value of early bone marrow MRD status in CAR-T therapy for myeloma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8022] [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
8022 Background: Bone marrow (BM) assessment of minimal residual disease (MRD) is being considered as a surrogate endpoint in clinical trials and is prognostic for survival in multiple myeloma (MM). Timing of BM assessment is variable across Chimeric Antigen Receptor T cell (CART) therapy trials and differs from standard of care practice. BM myeloma cell clearance can be detected by month 1 post CART, even before serum immunofixation becomes negative. BM is still hypocellular at month 1, thus prognostic value of MRD negative (MRDneg) at this timepoint is unclear. We examined impact of Day 30 MRD status in patients (pts) who received CART at Mayo Clinic. Methods: Medical records were reviewed retrospectively for MM pts who received CART between 8/2016 and 6/2021. PFS and OS were plotted by Kaplan-Meier method. Results: Sixty MM pts received CART and had BM biopsy at month 1. Median age was 62 yrs, 53% were male, and 78% were BM MRDneg by flow cytometry. Baseline demographics were similar between MRDneg and MRD+ (Table). Overall, 85% (40/47) who were month 1 BM MRDneg had i/u FLC<normal. Patients who achieved CR/sCR had higher rates of BM MRDneg (100% vs 61%, p<0.001) and i/u FLC< normal (89% vs 58%, p<0.001). At month 1, 24/60 (40%) pts had hypocellular BM. Serial BM samples at month 3 (n=35), 6 (n=28) and 12 (n=23) showed MRDneg rate of 93% (25/27), 56% (9/16) 58% (7/12), respectively.. Rate of hypocellularity was 54% (19/35), 32% (9/28) and 30% (7/23), respectively. Among the MRDneg/hypocellular pts at month 1, hypocellular BM was seen in 8/11 (73%) pts at month 3 and 2/4 (50%) pts at month 6 and 12. Compared to MRD+, pts who had BM MRDneg at months1 had longer PFS (Table). PFS was not statistically significantly different between pts who had BM MRDneg and were either hypocellular or not. MRDneg pts with i/u FLC<normal at months1 had better median PFS compared to those who did not. (MRD+:2.9 months (1.2-NR). MRDneg/FLC>normal: 4.9 months (2.3-NR). vs MRDneg/FLC<normal:17.9 months (11.8-NR), p<0.0001). Conclusions: Hypocellular BM is common in the 3 months post CART. Regardless of BM cellularity, BM MRDneg at month 1 correlates with deep response and prolonged PFS. Majority of BM MRDneg pts at month 1 also had FLC<normal. BM MRDneg status and FLC normalization were associated with longer survival. Our data support the continued evaluation of BM early post CART infusion as a prognostic tool. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Rafael Fonseca
- Division of Hematology/Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | | | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
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5
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Mohty R, Thoendel M, Swei S, Bansal R, Palmer J, Hogan WJ, Vergidis P, Munoz J, Iqbal M, Yassine F, Bennani NN, Hathcock M, Murthy HS, Castro JE, Lin Y, Razonable RR, Kharfan-Dabaja M. Treatment with anti-spike monoclonal antibodies in allogeneic HCT and CAR T-cell recipients with mild to moderate COVID-19: The Mayo Clinic experience. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19049] [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
e19049 Background: Prognosis of COVID-19 is poor in the setting of immunosuppression. Casirivimab/imdevimab (REGEN-COV), bamlanivimab, and sotrovimab are investigational monoclonal antibodies (MoAbs) authorized for treatment of mild/moderate COVID-19 for patients (pts) 12 years or older and who are at high-risk for progression to severe COVID-19. These neutralizing antibodies, against SARS-CoV-2 spike proteins, have been shown to decrease risk of progression to severe disease. Recipients of allogeneic stem cell transplants (allo-SCT) or chimeric antigen T cell therapy (CAR T cell) represent a high risk population. However, treatment outcomes with these MoAbs in these pts are not well described. Methods: This retrospective study included 33 consecutive adult pts who developed mild/moderate COVID-19 and received anti-spike SARS-CoV-2 MoAbs between December 2020 and November 2021. Allo-SCT (N=27) or CAR T cell (N=6) recipients were included, and outcomes were analyzed separately. Pts received REGEN-COV (N=19), bamlanivimab (N=11), or sotrovimab (N=1), missing (N=2). Results: In the allo-SCT cohort (N=27), median age at time of COVID-19 was 55 (23-76) years. Median time from allo-SCT to COVID-19 was 31 (22-64) months. Two pts received CAR T-cell therapy prior to allo-SCT. Diagnoses included leukemia or myeloid diseases (82%), lymphoma (11%), or myeloma (7%). Transplant characteristics are summarized (Table). Thirteen pts were vaccinated against SARS-CoV-2 prior to breakthrough COVID-19. Events considered included hospitalization due to COVID-19, disease progression, or death from any cause. The 6-month event-free and overall survivals were 81% and 91%, respectively. In the CAR T cell recipients cohort (N=6), 4 pts received axicabtagene ciloleucel for diffuse large B-cell or follicular lymphoma and 2 received brexucabtagene autoleucel for mantle cell lymphoma. The median follow-up was 8 (1-11) months. Two pts received autologous SCT prior to COVID-19. Median time from CAR T cell therapy to COVID-19 was 10 (3-24) months. Three pts were vaccinated prior to COVID-19. Only 1 pt was hospitalized due to severe COVID-19 requiring mechanical ventilation leading to death. Conclusions: These results show a potential benefit of MoAbs in high-risk pts, namely allo-SCT or CAR T cell recipients. Future studies should evaluate the role of prophylactic use MoAbs in these populations. A comparative analysis with a matched control cohort (who did not receive MoAbs) will be provided at the meeting. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - Javier Munoz
- Division of Hematology, Mayo Clinic, Gilbert, AZ
| | - Madiha Iqbal
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
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6
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Bansal R, Baksh M, Larsen JT, Hathcock M, Dingli D, Stewart K, Kapoor P, Kourelis T, Hayman SR, Warsame R, Fonseca R, Bergsagel PL, Ailawadhi S, Kumar S, Lin Y. Prognostic Value of Early Bone Marrow MRD Status in CAR-T Therapy for Myeloma. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Bezerra ED, Muñoz J, Murthy H, Khurana A, Bansal R, Iqbal M, Maurer MJ, Hathcock M, Johnston PB, Bennani NN, Paludo J, Wang Y, Villasboas JC, Rosenthal A, Ansell S, Witzig TE, Castro JE, Kharfan-Dabaja MA, Nowakowski GS, Lin Y. Barriers to Enrollment in Clinical Trials in Patients with Aggressive B-Cell Non-Hodgkin Lymphoma That Progressed after Anti-CD19 CART Cell Therapy. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00696-0] [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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8
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Wiedmeier-Nutor JE, Iqbal M, Muñoz J, Bezerra ED, Garcia Robledo JE, Bansal R, Johnston PB, Hathcock M, Larsen JT, Bergsagel PL, Wang Y, Reeder C, Leis JF, Fonseca R, Palmer J, Warsame R, Kourelis T, Hayman SR, Dingli D, Kapoor P, Villasboas JC, Paludo J, Bennani NN, Ansell S, Castro JE, Kharfan-Dabaja MA, Lin Y, Vergidis P, Murthy H, Rosenthal A. Response to COVID-19 Vaccination Post-CAR T Therapy in Patients with Non-Hodgkin Lymphoma and Multiple Myeloma. Transplant Cell Ther 2022. [PMCID: PMC8930047 DOI: 10.1016/s2666-6367(22)00400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Melody M, Gandhi S, Saunders H, Abdel-Rahman Z, Hastings J, Lengerke Diaz P, Gannon N, Truong T, Hathcock M, Khurana A, Johnston P, Ansell S, Bennani N, Paludo J, Bisneto JV, Wang Y, Rosenthal A, Foran J, Ayala E, Murthy HS, Roy V, Castro JE, Lin Y, Kharfan-Dabaja MA. Incidence of thrombosis in relapsed/refractory B-cell lymphoma treated with axicabtagene ciloleucel: Mayo Clinic experience. Leuk Lymphoma 2022; 63:1363-1368. [PMID: 35109766 DOI: 10.1080/10428194.2022.2030475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is effective in relapsed/refractory large B-cell lymphoma and results in a unique toxicity profile, namely cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome. The hyper-inflammatory state associated with these toxicities has been suggested to increase the risk of thrombosis. We conducted a retrospective analysis of patients treated with axicabtagene ciloleucel (axi-cel) to assess the rate of thrombosis with axi-cel therapy from the time of CAR T-cell infusion until the end of hospitalization, when performed in the inpatient setting, or up to day +30 when performed in the outpatient setting. Ninety-two (95%) of 97 patients were hospitalized during axi-cel therapy and 85 (88%) developed CRS. Fifty-five patients (57%) received concurrent anticoagulation (53 as prophylaxis). Patients with prior VTE did not have progression or evidence of new VTE. Only 2 (2.1%) patients developed VTE. These results demonstrate a low-risk for thrombosis in axi-cel recipients.
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Affiliation(s)
- Megan Melody
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Hollie Saunders
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Zaid Abdel-Rahman
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Jacquelyn Hastings
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Paula Lengerke Diaz
- Division of Hematology-Oncology and Blood and Marrow Transplantation, Mayo Clinic, Phoenix, AZ, USA
| | - Nicole Gannon
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Tuan Truong
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Allison Rosenthal
- Division of Hematology-Oncology and Blood and Marrow Transplantation, Mayo Clinic, Phoenix, AZ, USA
| | - James Foran
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Ernesto Ayala
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Vivek Roy
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Januario E Castro
- Division of Hematology-Oncology and Blood and Marrow Transplantation, Mayo Clinic, Phoenix, AZ, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
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10
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Khurana A, Hathcock M, Habermann TM, Al Saleh AS, Gandhi S, Truong T, Bennani NN, Paludo J, Villasboas JC, Ansell SM, Inwards DJ, Porrata LF, Johnston PB, Micallef I, Lin Y. Lines of therapy before autologous stem cell transplant and CAR-T affect outcomes in aggressive Non-Hodgkin's lymphoma. Am J Hematol 2021; 96:E386-E389. [PMID: 34260759 DOI: 10.1002/ajh.26293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Arushi Khurana
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | - Abdullah S. Al Saleh
- College of Medicine King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia
| | | | - Tuan Truong
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Jonas Paludo
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | | | | | | | - Ivana Micallef
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Yi Lin
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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11
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Bansal R, Paludo J, Holland A, Megan S, Alli M, Hathcock M, Alkhateeb H, Dingli D, Wang Y, Kenderian S, Kumar S, Shah MV, Mustaqeem S, Warsame RM, Villasboas JC, Bennani NN, Johnston PB, Ansell SM, Haddad TC, Lin Y. Outpatient practice pattern and remote patient monitoring for axicabtagene ciloleucel CAR-T therapy in patients with aggressive lymphoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7554 Background: Chimeric antigen receptor T-cell therapy (CAR-T) are commonly administered inpatient due to concern for early onset cytokine release syndrome (CRS), especially with axicabtagene ciloleucel (axi-cel). We report Mayo Clinic Rochester experience for hospital-based outpatient (HBO) management of patients (pts) receiving axi-cel and identify opportunities for improvement. HBO is closely integrated with inpatient practice and includes the same specialty trained clinical team. It is the first point of contact 24/7 for pts and triage evaluations. Lymphodepletion chemotherapy and CAR-T infusion is given on HBO followed by daily monitoring till day 8 and thereafter, as clinically needed until admission criteria is met. Methods: We retrospectively analyzed database of pts who received axi-cel between 1/2018 and 1/2021. After 06/2020, remote patient monitoring (RPM) tools were implemented to collect patient-reported neurologic symptoms and vital signs via bluetooth-enabled devices 4 times daily through month 1. Adverse data trends are addressed by the HBO team. Results: Among 72 recipients, 89% received their cells outpatient; 8% remained outpatient for the entire month. CRS and neurotoxicity incidence were comparable to those reported from CIBMTR. Median time to first admission was 2 days (Table). Use of bridging therapy, increased CRP and LDH were associated with early admission (≤3 days). Median time to tocilizumab, steroid, oxygen support, vasopressor was 4 days after admission. Half of HBO visits required intervention such as blood transfusions, IV medications through the first month. Nine pts had enrolled in RPM to date; with 8 having evaluable data. With 4 scheduled entries/day, a median of 1 entry/day was skipped and 2 entries/day were answered incompletely. An average of 57 additional unscheduled entries were generated per pt. Among a median of 373 (range 91-522) readings per pt over the first month, 4% (2%-20%) of the readings generated alerts. An average of 4 alerts were seen within 48 hours prior to admission. Data including additional subjects will be presented at ASCO meeting. Conclusions: We report a feasible outpatient care model for management of axi-cel recipients with safe outcomes. Clinical characteristics associated with more aggressive disease are associated with likelihood of early admission. Early RPM experience suggest use of digital tools could improve monitoring compliance and may predict evolution to symptoms requiring escalation of care.[Table: see text]
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Affiliation(s)
| | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | | | | | | | | | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | | | | | | | | | | | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
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12
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Wudhikarn K, Bansal R, Khurana A, Hathcock M, Bennani NN, Paludo J, Villasboas JC, Wang Y, Johnston PB, Ansell SM, Lin Y. The impact of body weight and body mass index on outcomes of diffuse large B-cell lymphoma treated with axicabtagene ciloleucel. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19554] [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
e19554 Background: Obesity is associated with a pro-inflammatory state and immune dysregulation. Retrospective studies indicate that obesity could affect toxicities and outcomes after immunotherapies including checkpoint inhibitors and allogeneic stem cell transplant. Currently, there are no data specifically on outcomes for obese patients who receive chimeric antigen receptor T (CAR-T) cells. We described the clinical outcome in obese patients with large B cell lymphoma (LBCL) who received axicabtagene ciloleucel (axi-cel). Methods: We analyzed the effect of body weight (BW) and body mass index (BMI) on toxicities and outcomes of 78 adults with LBCL who received axi-cel between June 2016 and October 2020 at Mayo Clinic. Obesity was defined as having BMI of 30 or higher. Results: Of 78 patients, 22 (28%) and 19 (24%) were classified as overweight (BMI 25-29.99 kg/m2) and obese (BMI ≥30 kg/m2), respectively. Baseline characteristics were not statistically significantly different between non-obese and obese patients. The median delivered dose of fludarabine was similar between non-obese and obese patients (89 [0-105] vs 88 [56-94] mg/m2, P=0.32) whereas the median delivered dose of cyclophosphamide was lower in non-obese patients (1503 [1077-1525] vs 1512 [1021-1660] mg/m2, P=0.01). The 30-days cumulative incidence of CRS and ICANS were similar between non-obese and obese patients. BW and BMI were not associated with CRS or ICANS. The overall response rate was 66% (CR 47%) and 68% (CR 53%) in non-obese and obese group, respectively ( P=0.83). The 1-year event free survival (EFS) and overall survival (OS) was 34.6% and 64.5%, neither were different between non-obese and obese patients (EFS 35.8% vs. 30.7%, P=0.60; OS 59.4% vs. 83.9%, P=0.18). The 1-year cumulative incidence of relapse and non-relapse mortality was comparable (60.8% vs. 69.0%, P=0.40 and 3.4% vs. 0%, P=0.42). In the Cox proportional hazards model, higher dose of fludarabine, but not cyclophosphamide, was associated with better EFS and OS; however, neither obesity nor BW were associated with toxicities and outcomes. Conclusions: In our study, Obesity was not associated with risk of toxicities or adverse survival outcomes. The effect of obesity on the pattern of LD chemotherapy dosing including toxicities and outcomes after CAR-T warrants further exploration. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
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Zhang H, Bansal R, Peterson Martinez K, Hathcock M, Shao Z, McCoy G, Gonzalez-Guerrico A, Bennani NN, Paludo J, Wang Y, Johnston P, Ansell SM, Kenderian S, Porrata LF, Villasboas JC, Lin Y. Prognostic role of lymphocyte to monocyte ratio in patients treated with CAR-T for aggressive lymphoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7558] [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
7558 Background: A low absolute lymphocyte to monocyte ratio (ALC/AMC) has been found to predict decreased survival in lymphoma patients receiving chemotherapy and stem cell transplant. We report its clinical significance and additional cellular phenotype changes in patients receiving chimeric antigen receptor T-cell (CART) therapy. Methods: Records were reviewed for patients (pts) who received axicabtagene ciloleucel between 6/2016 and 12/2020. Receiver operator curve was generated using nominal logistic regression to predict CR as best response. Survivals were calculated using Kaplan- Meier method. Blood immune phenotype were assayed by multiparametric flow. Principle component analysis (PCA) was performed using ClusterVis. Results: Low ALC/AMC (≤0.8) prior to lymphodepletion (LD) chemotherapy on day -5 was associated with lower CR rate (AUC=0.68, Table). Our cohort of 81 pts had similar baseline characteristics except that noted in Table. Low ALC/AMC ratio is associated with shorter EFS and OS (EFS: 2.6 vs. 6.4 months, P<0.0001; OS: 5.3 months vs. not reached, P=0.0006), respectively. Prognostic association remained significant in multivariate analysis including ASCT, bridging therapy and CRP. Interestingly, compared to the high ALC/AMC group, the low ALC/AMC group had decreased CD8 Tem, increased CD16+CCR2+ monocytes and increased monocytes’ producing IL12, IL-10, and IL-1β (n=26). Unsupervised PCA identified 3 clusters: 1. Low ALC/AMC, all non-CR; 2. High ALC/AMC, some non-CR; 3. High ALC/AMC, all CR. Compared to cluster 1 and 2, cluster 3 had increased CD4 Tnaive, CD8 Tcm and IL-17 producing CD4 T and NK cells. Conclusions: ALC/AMC is a clinically accessible test that is strongly associated with CAR-T response and survival. Immune characterization revealed that the biologic effect is not just associated with cell ratio. Increased inflammation has been found to negatively impact CAR-T response, with some cytokines known to be from the myeloid lineage. We show that CRP is elevated in the low ALC/AMC group with increased cytokine production by monocytes. In addition, presence of T cell subset and IL-17 producing cells, before LD, are associated with clinical response. Further investigation on optimizing host immunity may help improve clinical outcome with CAR-T.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
| | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
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Wudhikarn K, Bansal R, Khurana A, Hathcock M, Ruff M, Carabenciov ID, Braksick SA, Bennani NN, Paludo J, Villasboas JC, Wang Y, Johnston PB, Ansell SM, Lin Y. Characteristics, outcomes, and risk factors of ICANS after axicabtagene ciloleucel: Does age matter? J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19556] [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
e19556 Background: CD19 chimeric antigen receptor T cell therapy possesses unique side effects including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Age is a major risk factor for ICANS. However, whether ICANS in older patients is different compared to younger patients is unknown. Herein, we report clinical course, outcomes and risk factors for ICANS in older patients with large B cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). Methods: We comprehensively reviewed detailed clinical courses of ICANS in 78 adult patients with LBCL treated with axi-cel between June 2016 and October 2020. Incidence, manifestation, risk factors, treatment, and outcomes of ICANS were compared between patients age ≥60 (n=32) and <60 (n=46) years old. Results: Baseline characteristics were comparable between older and younger patients except higher proportion of high international prognostic index and underlying cerebral microvascular disease in older patients. ICANS was observed in 16 patients in the older and 24 patients in the younger age group, with a 30-day incidence of 52% and 50%, respectively. Median time to CRS and ICANS were similar between 2 age groups. The most common initial neurological findings included aphasia, dysgraphia and encephalopathy in both age groups. Table summarizes the characteristics, clinical course and interventions of ICANS in older and younger patients. In Cox regression model, the presence of CRS was the only factor associated with ICANS in both age groups. Age, history of central nervous system involvement and cerebral microvascular disease were not associated with ICANS. Importantly, all patients had complete resolution of ICANS. No elderly patients in our cohort experienced seizure as a manifestation of ICANS. Conclusions: In our study, older age was not a risk factor for ICANS. CRS was the only factor associated with ICANS in both younger and older patients. Incidence, clinical course and neurological outcomes of ICANS in older patients treated with axi-cel were comparable to younger patients. [Table: see text]
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Affiliation(s)
| | | | | | | | - Michael Ruff
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | | | | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
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15
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Bansal R, Vergidis P, Tosh P, Wilson JW, Hathcock M, Bennani NN, Paludo J, Villasboas JC, Wang Y, Ansell SM, Johnston PB, Freeman CM, Lin Y. Vaccine titers in lymphoma patients receiving chimeric antigen receptor T-cell therapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7555] [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
7555 Background: While CAR-T therapy is not myelo-ablative, patients with aggressive lymphoma treated with CD19 chimeric antigen receptor T cell therapy (CAR-T) are lymphodepleted and have prolonged B cell aplasia. The impact of CAR-T on immunologic protection from vaccine-preventable diseases (and thus the need to revaccinate) is not known. We report the vaccine titers of patients treated with axicabtagene ciloleucel (axi-cel) at Mayo Clinic. Methods: Retrospective chart review of adult lymphoma patients who received axi-cel from 9/2018 to 9/2020 for anti-viral and anti-bacterial titers prior to CAR-T infusion and at month 3 (MO3) post CAR-T. Results: Prior to CAR-T therapy, positive titer rate was highest for tetanus and lowest for Strep pneumoniae (Strep PNA) (Table). Similar trends were seen whether patients had stem cell transplant (ASCT) within 2 years of CAR-T (i.e. within immunization timeframe post ASCT) or not (Table). Compared to patients who had ASCT, those who did not had higher rate of positive titer for Strep PNA and lower rate for hepatitis B, Mumps, and VZV. The same trend for sero-positive rate were observed at MO3 post CAR-T. Patients with IgG<400 mg/dl received IVIG supplement for prophylaxis. Among the 23 patients who received IVIG, variable rate of conversion from negative to positive titers were seen for measles (1/2, 50%), mumps (2/3, 67%), rubella (2/3, 67%), varicella-zoster (VZV, 3/3, 100%), hepatitis A (6/6, 100%), hepatitis B (6/7, 86%) and Strep PNA (0/10, 0%). For patients who did not receive IVIG prophylaxis, there was one loss of seropositivity for Strep PNA (1/4, 25%). Conclusions: The presence of protective vaccine titers is variable for patients receiving CAR-T, regardless of recent ASCT. The loss of protective titers post CART was low. IVIG variably impacted vaccine titer status. Immunization remains important for patients with ASCT prior to CART, without completion of post ASCT immunization protocol. Further study is needed to inform the need for immunization and optimal timing post CART.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
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Kolbe AB, Ibirogba ER, Thomas KB, Hull NC, Thacker PG, Hathcock M, Sangi-Haghpeykar H, Ruano R. Reproducibility of Lung and Liver Volume Measurements on Fetal Magnetic Resonance Imaging in Left-Sided Congenital Diaphragmatic Hernia. Fetal Diagn Ther 2021; 48:258-264. [PMID: 33756472 DOI: 10.1159/000512491] [Citation(s) in RCA: 3] [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: 08/05/2020] [Accepted: 10/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Congenital diaphragmatic hernia (CDH) affects 1 in 3,000 live births and is associated with significant morbidity and mortality. METHODS A review of fetal magnetic resonance imaging (MRI) examinations was performed for fetuses with left CDH and normal lung controls. Image review and manual tracings were performed by 4 pediatric radiologists; right and left lung volumes in the coronal and axial planes as well as liver volume above and below the diaphragm in the coronal plane were measured. Intra- and interreviewer reproducibility was assessed using intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS Excellent intra- and interreviewer reproducibility of the right and left lung volume measurements was observed in both axial planes (interreviewer ICC: right lung: 0.97, 95% CI: 0.95-0.99; left lung: 0.97, 95% CI: 0.95-0.98) and coronal planes (interreviewer ICC: right lung: 0.97, 95% CI: 0.95-0.98; left lung: 0.96, 95% CI: 0.93-0.98). Moderate-to-good interreviewer reproducibility was observed for liver volume above the diaphragm (ICC 0.7, 95% CI: 0.59-0.81). Liver volume below the diaphragm had a good-to-excellent interreviewer reproducibility (ICC 0.88, 95% CI: 9.82-0.93). CONCLUSIONS The present study demonstrated an excellent intra- and interreviewer reproducibility of MRI lung volume measurements and good-to-moderate inter- and intrareviewer reproducibility of liver volume measurements after standardization of the methods at our fetal center.
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Affiliation(s)
- Amy B Kolbe
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eniola R Ibirogba
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kristen B Thomas
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Paul G Thacker
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Matthew Hathcock
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA,
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Bansal R, Paludo J, Spychalla M, McClanahan A, Holland A, Truong T, Hathcock M, Alkhateeb HB, Dingli D, Hayman SR, Kapoor P, Kenderian SS, Kourelis T, Kumar S, Shah MV, Siddiqui M, Warsame R, Bisneto JV, Bennani NN, Johnston PB, Ansell S, Lin Y. Outpatient Practice Pattern and Clinical Outcome for Axicabtagene Ciloleucel in Patients with Aggressive Lymphoma. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Barreto JN, Bansal R, Hathcock M, Doleski C, Hayne J, Truong T, Ansell S, Bennani NN, Paludo J, Villasboas Bisneto JC, Lin Y, Johnston PB. The Utility of Granulocyte Colony Stimulating Factor in Patients Receiving Chimeric Antigen Receptor T-Cell Therapy with Axicabtagene Ciloleucel. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Khurana A, Hathcock M, Habermann TM, Al Saleh AS, Gandhi S, Truong T, Bennani NN, Paludo J, Bisneto JV, Ansell S, Inwards DJ, Porrata LF, Johnston PB, Micallef IN, Lin Y. Lines of Therapy before Autologous Stem Cell Transplant (ASCT) and CAR-T Infusion Affect Outcomes in Aggressive Non-Hodgkin’s Lymphoma (NHL). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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Melody M, Gandhi S, Saunders H, Abdel-Rahman Z, Hastings J, Diaz PL, Truong T, Hathcock M, Khurana A, Johnston PB, Ansell S, Bennani NN, Paludo J, Bisneto JV, Wang Y, Rosenthal A, Foran J, Ayala E, Murthy H, Roy V, Castro JE, Lin Y, Kharfan-Dabaja MA. Risk of Thrombosis in CAR T-Cell Therapy Recipients. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00535-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Takahashi PY, Ryu E, Bielinski SJ, Hathcock M, Jenkins GD, Cerhan JR, Olson JE. No Association Between Pharmacogenomics Variants and Hospital and Emergency Department Utilization: A Mayo Clinic Biobank Retrospective Study. Pharmgenomics Pers Med 2021; 14:229-237. [PMID: 33603442 PMCID: PMC7886254 DOI: 10.2147/pgpm.s281645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023]
Abstract
Background The use of pharmacogenomics data is increasing in clinical practice. However, it is unknown if pharmacogenomics data can be used more broadly to predict outcomes like hospitalization or emergency department (ED) visit. We aim to determine the association between selected pharmacogenomics phenotypes and hospital utilization outcomes (hospitalization and ED visits). Methods This cohort study utilized 10,078 patients from the Mayo Clinic Biobank in the RIGHT protocol with sequence and interpreted phenotypes for 10 selected pharmacogenes including CYP2D6, CYP2C9, CYP2C19, CYP3A5, HLA B 5701, HLA B 5702, HLA B 5801, TPMT, SLCO1B1, and DPYD. The primary outcome was hospitalization with ED visits as a secondary outcome. We used Cox proportional hazards model to test the association between each pharmacogenomics phenotype and the risk of the outcomes. Results During the follow-up period (median [in years] = 7.3), 13% (n=1354) and 8% (n=813) of the subjects experienced hospitalization and ED visits, respectively. Compared to subjects who did not experience hospitalization, hospitalized patients were older (median age [in years]: 67 vs 65), poorer self-rated health (15% vs 4.7% for fair/poor), and higher disease burden (median number of chronic conditions: 7 vs 4) at baseline. There was no association of hospitalization with any of the pharmacogenomics phenotypes. The pharmacogenomics phenotypes were not associated with disease burden, a well-established risk factor for hospital utilization outcomes. Similar findings were observed for patients with ED visits during the follow-up period. Conclusion We found no association of 10 well-established pharmacogenomics phenotypes with either hospitalization or ED visits in this relatively large biobank population and outside the context of specific drug use related to these genes. Traditional risk factors for hospitalization like age and self-rated health were much more likely to predict hospitalization and/or ED visits than this pharmacogenomics information.
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Affiliation(s)
- Paul Y Takahashi
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Euijung Ryu
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Suzette J Bielinski
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew Hathcock
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Gregory D Jenkins
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James R Cerhan
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Janet E Olson
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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22
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Miller C, Shenoy C, Zhao Y, Duong S, Hathcock M. OUTCOMES OF FROZEN OOCYTE DONOR IN VITRO FERTILIZATION (IVF) CYCLES USING FRESH VERSUS FROZEN SPERM. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.758] [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: 10/23/2022]
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23
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Swieboda D, Johnson EL, Beaver J, Haddad L, Enninga EAL, Hathcock M, Cordes S, Jean V, Lane I, Skountzou I, Chakraborty R. Baby's First Macrophage: Temporal Regulation of Hofbauer Cell Phenotype Influences Ligand-Mediated Innate Immune Responses across Gestation. J Immunol 2020; 204:2380-2391. [PMID: 32213562 DOI: 10.4049/jimmunol.1901185] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/21/2020] [Indexed: 12/20/2022]
Abstract
The importance of fetal placental macrophages (Hofbauer cell [HCs]) is underscored by their appearance 18 d postconception and maintenance through term; however, how human HCs evolve during healthy pregnancy and how microenvironment and ontogeny impact phenotype and function remain unknown. In this study, we comprehensively classify human HCs ex vivo, interrogate phenotypic plasticity, and characterize antiviral immune responses through gestation. Activated HCs were abundant in early pregnancy and decreased by term; molecular signatures emphasize inflammatory phenotypes early in gestation. Frequency of HCs with regulatory phenotypes remained high through term. Furthermore, term HCs exhibited blunted responses to stimulation, indicating reduced plasticity. IFN-λ1 is a key placental IFN that appeared less protective than IFN-α, suggesting a potential weakness in antiviral immunity. Ligand-specific responses were temporally regulated: we noted an absence of inflammatory mediators and reduced antiviral gene transcription following RIG-I activation at term despite all HCs producing inflammatory mediators following IFN-γ plus LPS stimulation. Collectively, we demonstrate sequential, evolving immunity as part of the natural history of HCs through gestation.
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Affiliation(s)
- Dominika Swieboda
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322.,Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322
| | - Erica L Johnson
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322
| | - Jacob Beaver
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322
| | - Lisa Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30322
| | - Elizabeth Ann L Enninga
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Alix School of Medicine, Rochester, MN 55905
| | - Matthew Hathcock
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Alix School of Medicine, Rochester, MN 55905; and
| | - Sarah Cordes
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30322
| | - Valerie Jean
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30322
| | - Ivy Lane
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322
| | - Ioanna Skountzou
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322
| | - Rana Chakraborty
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322; .,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Alix School of Medicine, Rochester, MN 55905.,Division of Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Alix School of Medicine, Rochester, MN 55905
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Abstract
OBJECTIVE The most common methods of sterilization during cesarean delivery rely on excision of a mid-segment of the fallopian tube. Contemporary data suggest ovarian cancers may originate in the fimbriae of the fallopian tube; therefore, a strategy of prophylactic salpingectomy (SL) has been adopted during gynecologic surgery. The purpose of this study was to evaluate the safety of SL compared to traditional mid-segment excision at time of cesarean and after vaginal delivery through change in perioperative hemoglobin (Hgb). STUDY DESIGN We retrospectively evaluated patients undergoing sterilization concurrent with cesarean delivery or in the post-vaginal delivery period between 1 January 2015 and 31 December 2017 in the Mayo Clinic Health System; a community-based practice. In order to test for non-inferiority, 30 patients in each arm (tubal ligation (TL) and SL) were required to detect a pre- and post-operative Hgb difference of 0.5 mg/dL between groups with a power of 80%. Exclusion criteria included: age <18 years, BMI >50 kg/m2, endometriosis, other concurrent surgical procedures, bleeding disorders, postpartum hemorrhage due to atony, trial of labor after cesarean (TOLAC), and the presence of ovarian masses. RESULTS One hundred fifty-two patients met inclusion criteria. There was no evidence of inferiority in either the post-vaginal delivery or the cesarean groups with a mean difference in pre- and post-op Hgb of 0.18 mg/dL (p = .99) post-cesarean and 0.04 mg/dL post-vaginal delivery with less reduction in Hgb from SL. The mean length of the procedure was 10.0 and 9.9 min (p = .005) longer for SL procedures amongst cesarean and postpartum procedures, respectively. Subgroup analyses did not demonstrate differences in blood loss between different techniques. Clamp-cut-tie techniques took longer than all other procedures in both groups. CONCLUSION This study provides evidence that the practice of salpingectomy at the time of cesarean and post-vaginal delivery may be safe and should form the basis of prospective trials.
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Affiliation(s)
- Pavan Parikh
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.,Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sharon Kim
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Rubin Raju
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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25
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Burkhart HM, Qureshi MY, Rossano JW, Cantero Peral S, O'Leary PW, Hathcock M, Kremers W, Nelson TJ. Autologous stem cell therapy for hypoplastic left heart syndrome: Safety and feasibility of intraoperative intramyocardial injections. J Thorac Cardiovasc Surg 2019; 158:1614-1623. [PMID: 31345560 DOI: 10.1016/j.jtcvs.2019.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Staged surgical palliation for hypoplastic left heart syndrome results in an increased workload on the right ventricle serving as the systemic ventricle. Concerns for cardiac dysfunction and long-term heart failure have generated interest in first-in-infant, cell-based therapies as an additional surgical treatment modality. METHODS A phase 1 clinical trial was conducted to evaluate the safety and feasibility of direct intramyocardial injection of autologous umbilical cord blood-derived mononuclear cells in 10 infants with hypoplastic left heart syndrome at the time of stage II palliation. RESULTS All 10 patients underwent successful stage II palliation and intramyocardial injection of umbilical cord blood-derived mononuclear cells. Operative mortality was 0%. There was a single adverse event related to cell delivery: An injection site epicardial bleed that required simple oversew. The cohort did not demonstrate any significant safety concerns over 6 months. Additionally, the treatment group did not demonstrate any reduction in cardiac function in the context of the study related intramyocardial injections of autologous cells. CONCLUSIONS This phase 1 clinical trial showed that delivering autologous umbilical cord blood-derived mononuclear cells directly into the right ventricular myocardium during planned stage II surgical palliation for hypoplastic left heart syndrome was safe and feasible. Secondary findings of preservation of baseline right ventricular function throughout follow-up and normalized growth rates support the design of a phase 2b follow-up trial.
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Affiliation(s)
- Harold M Burkhart
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma, Oklahoma City, Okla.
| | | | - Joseph W Rossano
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pa
| | | | | | - Matthew Hathcock
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | - Walter Kremers
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | - Timothy J Nelson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn; Division of General Internal Medicine, Mayo Clinic, Rochester, Minn; Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minn; Center for Regenerative Medicine, Mayo Clinic, Rochester, Minn
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26
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Sutton EJ, Pacyna JE, Hathcock M, McCormick JB, Nowakowski K, Olson JE, Sharp RR. Managing the Unimaginable: Biobank Participant Views on Reconsent for Whole Genome Sequencing of Stored Biospecimens. Biopreserv Biobank 2019; 17:296-302. [PMID: 30912675 DOI: 10.1089/bio.2018.0077] [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] [Indexed: 11/12/2022] Open
Abstract
Background: DNA biobanks frequently obtain broad permissions from sample donors, who agree to allow their biospecimens to be used for a variety of future purposes. A limitation of this approach is that it may not be possible to discuss or anticipate all potential uses of biospecimens at the time patient consent is obtained. We surveyed biobank participants to clarify their views regarding the need to be informed about research involving whole genome sequencing (WGS). Methods: We invited 1200 participants in the Mayo Clinic Biobank to complete a survey inquiring about their support for WGS; their interest in being recontacted before WGS of their biospecimens; whether they would consent to WGS if asked; and the acceptability of proceeding with WGS if sample donors could not be reached. Results: Six hundred eighty-seven biobank participants returned completed surveys (57% response). More than 96% of biobank participants were supportive of WGS and would give permission for WGS of their sample, if asked. Nonetheless, 61% of biobank participants felt they should be recontacted before WGS was done. Participants were divided regarding the permissibility of conducting WGS if efforts to recontact sample donors were unsuccessful. Discussion: Our findings highlight a potential discrepancy between the broad permissions granted by biobank participants at the time they donated biospecimens and their views about the application of WGS to their samples. Biobank participants appear to value the ability to confirm their commitment to genetic research when the studies in question involve WGS, a technological capacity they may not have anticipated at the time they donated their biospecimens. Efforts to reevaluate biobank participants' views about the acceptability of new technologies may help to ensure alignment of participants' current beliefs and research applications that would have been difficult to anticipate at the time biospecimens were collected.
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Affiliation(s)
- Erica J Sutton
- 1Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota.,2Center for Individualized Medicine, and Mayo Clinic, Rochester, Minnesota.,3Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Joel E Pacyna
- 1Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota.,2Center for Individualized Medicine, and Mayo Clinic, Rochester, Minnesota
| | - Matthew Hathcock
- 3Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jennifer B McCormick
- 4Department of Humanities, College of Medicine, Pennsylvania State University, University Park, Texas
| | | | - Janet E Olson
- 3Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Richard R Sharp
- 1Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota.,2Center for Individualized Medicine, and Mayo Clinic, Rochester, Minnesota.,3Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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27
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Asleh R, Snipelisky D, Hathcock M, Kremers W, Liu D, Batzler A, Jenkins G, Kushwaha S, Pereira NL. Genomewide association study reveals novel genetic loci associated with change in renal function in heart transplant recipients. Clin Transplant 2018; 32:e13395. [PMID: 30160337 DOI: 10.1111/ctr.13395] [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: 06/29/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Renal dysfunction occurs commonly after heart transplantation (HTx) with wide inter-individual variability but whether a genetic predisposition exists in these patients is unknown. Genomewide association studies (GWAS) have not been performed to assess the association of genetic variation with change in renal function after HTx. METHODS Clinical and demographic data of patients who underwent HTx and provided blood samples and consent for genetic analysis were included. Genotyping was performed using Illumina Infinium Human CoreExome v1.0 analysis kit. A GWAS utilizing linear regression models was performed with estimated glomerular filtration rate (eGFR) at 1 year as the phenotype after adjusting for baseline eGFR prior to HTx and conversion from calcineurin inhibitor to sirolimus as primary immunosuppression therapy. RESULTS A total of 251 HTx recipients were genotyped for 314,903 single nucleotide polymorphisms (SNPs). The mean (SD) age was 50 (12.5) years; most patients were of European origin (n = 243, 96.8%) and males (n = 179, 71.3%). After adjustment for potential confounders, two variants, rs17033285 (P = 4.3 × 10-7 ) and rs4917601 (P = 6.46 × 10-7 ), in a long non-coding RNA (lncRNA) gene LINC01121 and a pseudogene BTBD7P2, were identified to have a significant association with change in GFR at 1 year after HTx. CONCLUSIONS Our first of its kind GWAS demonstrates that genetic variation affects renal function after HTx independent of other risk factors. Agnostic genetic approaches such as these may lead to identification of novel biological pathways such as the role of lncRNAs in the development of renal dysfunction post-HTx.
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Affiliation(s)
- Rabea Asleh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David Snipelisky
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Hathcock
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Walter Kremers
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Duan Liu
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Anthony Batzler
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Gregory Jenkins
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Sudhir Kushwaha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Naveen L Pereira
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
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Ainsworth AJ, Wyatt MA, Hathcock M, Borowski K, Coddington CC. The effect of fresh vs. frozen embryo transfer on neonatal and pediatric weight and weight gain trajectory. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.02.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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29
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Holman MA, Ainsworth A, Hathcock M, Borowski K, Coddington C. 444: Effect of fresh versus frozen embryo transfer on fetal growth parameters. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Chen J, Ryu E, Hathcock M, Ballman K, Chia N, Olson JE, Nelson H. Impact of demographics on human gut microbial diversity in a US Midwest population. PeerJ 2016; 4:e1514. [PMID: 26839739 PMCID: PMC4734456 DOI: 10.7717/peerj.1514] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/26/2015] [Indexed: 12/21/2022] Open
Abstract
The clinical utility of microbiome biomarkers depends on the reliable and reproducible nature of comparative results. Underappreciation of the variation associated with common demographic, health, and behavioral factors may confound associations of interest and generate false positives. Here, we present the Midwestern Reference Panel (MWRP), a resource for comparative gut microbiome studies conducted in the Midwestern United States. We analyzed the relationships between demographic and health behavior-related factors and the microbiota in this cohort, and estimated their effect sizes. Most variables investigated were associated with the gut microbiota. Specifically, body mass index (BMI), race, sex, and alcohol use were significantly associated with microbial β-diversity (P < 0.05, unweighted UniFrac). BMI, race and alcohol use were also significantly associated with microbial α-diversity (P < 0.05, species richness). Tobacco use showed a trend toward association with the microbiota (P < 0.1, unweighted UniFrac). The effect sizes of the associations, as quantified by adjusted R2 values based on unweighted UniFrac distances, were small (< 1% for all variables), indicating that these factors explain only a small percentage of overall microbiota variability. Nevertheless, the significant associations between these variables and the gut microbiota suggest that they could still be potential confounders in comparative studies and that controlling for these variables in study design, which is the main objective of the MWRP, is important for increasing reproducibility in comparative microbiome studies.
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Affiliation(s)
- Jun Chen
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States; Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota , United States
| | - Matthew Hathcock
- Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota , United States
| | - Karla Ballman
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States; Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, New York, New York, United States
| | - Nicholas Chia
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States; Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, United States; Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota , United States
| | - Heidi Nelson
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, United States; Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States
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31
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Bhat M, Hathcock M, Kremers WK, Darwish Murad S, Schmit G, Martenson J, Alberts S, Rosen CB, Gores GJ, Heimbach J. Portal vein encasement predicts neoadjuvant therapy response in liver transplantation for perihilar cholangiocarcinoma protocol. Transpl Int 2015; 28:1383-91. [DOI: 10.1111/tri.12640] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 05/04/2015] [Accepted: 07/10/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Mamatha Bhat
- Division of Gastroenterology and Hepatology; Mayo Clinic; Rochester MN USA
| | - Matthew Hathcock
- Department of Health Sciences Research; Mayo Clinic; Rochester MN USA
| | - Walter K. Kremers
- Department of Health Sciences Research; Mayo Clinic; Rochester MN USA
| | | | - Grant Schmit
- Department of Radiology; Mayo Clinic; Rochester MN USA
| | - James Martenson
- Department of Radiation Oncology; Mayo Clinic; Rochester MN USA
| | | | - Charles B. Rosen
- Division of Transplantation Surgery; Mayo Clinic; Rochester MN USA
| | - Gregory J. Gores
- Division of Gastroenterology and Hepatology; Mayo Clinic; Rochester MN USA
| | - Julie Heimbach
- Division of Transplantation Surgery; Mayo Clinic; Rochester MN USA
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32
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Beebe-Dimmer JL, Hathcock M, Yee C, Okoth LA, Ewing CM, Isaacs WB, Cooney KA, Thibodeau SN. The HOXB13 G84E Mutation Is Associated with an Increased Risk for Prostate Cancer and Other Malignancies. Cancer Epidemiol Biomarkers Prev 2015; 24:1366-72. [PMID: 26108461 DOI: 10.1158/1055-9965.epi-15-0247] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/11/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A rare nonconservative substitution (G84E) in the HOXB13 gene has been shown to be associated with risk of prostate cancer. DNA samples from male patients included in the Mayo Clinic Biobank (MCB) were genotyped to determine the frequency of the G84E mutation and its association with various cancers. METHODS Subjects were genotyped using a custom TaqMan (Applied Biosystems) assay for G84E (rs138213197). In addition to donating a blood specimen, all MCB participants completed a baseline questionnaire to collect information on medical history and family history of cancer. RESULTS Forty-nine of 9,012 male patients were carriers of G84E (0.5%). Thirty-one percent (n = 2,595) of participants had been diagnosed with cancer, including 51.1% of G84E carriers compared with just 30.6% of noncarriers (P = 0.004). G84E was most frequently observed among men with prostate cancer compared with men without cancer (P < 0.0001). However, the mutation was also more commonly observed in men with bladder cancer (P = 0.06) and leukemia (P = 0.01). G84E carriers were more likely to have a positive family history of prostate cancer in a first-degree relative compared to noncarriers (36.2% vs. 16.0%, P = 0.0003). CONCLUSIONS Our study confirms the association between the HOXB13 G84E variant and prostate cancer and suggests a novel association between G84E and leukemia and a suggestive association with bladder cancer. Future investigation is warranted to confirm these associations in order to improve our understanding of the role of germline HOXB13 mutations in human cancer. IMPACT The associations between HOXB13 and prostate, leukemia, and bladder suggest that this gene is important in carcinogenesis.
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Affiliation(s)
- Jennifer L Beebe-Dimmer
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan. Barbara Ann Karmanos Cancer Institute, Detroit, Michigan.
| | - Matthew Hathcock
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota
| | - Cecilia Yee
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan. Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Linda A Okoth
- Departments of Internal Medicine and Urology, University of Michigan School of Medicine, Ann Arbor, Michigan. University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Charles M Ewing
- Department of Urology, Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William B Isaacs
- Department of Urology, Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathleen A Cooney
- Departments of Internal Medicine and Urology, University of Michigan School of Medicine, Ann Arbor, Michigan. University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Stephen N Thibodeau
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Hashmi S, Taner T, Patnaik M, Leise M, Hathcock M, Kremers WK, Hogan W, Litzow MR. Liver Transplantation for Hepatic Graft-Versus-Host-Disease: A United Network for Organ Sharing (UNOS) Database Study. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.528] [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: 11/28/2022]
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