1
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Mohan M, Schinke C. Risk stratification in multiple myeloma: Are we there yet? Br J Haematol 2024. [PMID: 38616560 DOI: 10.1111/bjh.19416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024]
Abstract
The second revision of international staging system (R2-ISS) shows promise in patients with multiple myeloma treated with a regimen of novel agent-based induction therapy, autologous stem cell transplant and maintenance therapy, but challenges persist. This study by Alzahrani et al. underscores the importance of refining risk assessment tools for tailored treatment strategies. Commentary on: Alzahrani et al. Impact of revised international staging system 2 (R2-ISS) risk stratification on outcomes of patients with multiple myeloma receiving autologous hematopoietic stem cell transplantation. Br J Haematol 2024 (Online ahead of print). doi: 10.1111/bjh.19384.
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Affiliation(s)
- Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Carolina Schinke
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, Arkansas, USA
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2
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Gong Z, Umoru G, Monge J, Shah N, Mohyuddin GR, Radhakrishnan SV, Chakraborty R, Rasche L, Schinke C, D'Souza A, Mohan M. Adverse effects and non-relapse mortality of BCMA directed T cell therapies in multiple myeloma: an FAERS database study. Blood Cancer J 2024; 14:36. [PMID: 38443341 PMCID: PMC10914796 DOI: 10.1038/s41408-024-01023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Zimu Gong
- Division of Hematology Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Godsfavour Umoru
- Division of Hematology Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Jorge Monge
- Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Nishi Shah
- Division of Hematological Malignancies, Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY, USA
| | | | | | - Rajshekhar Chakraborty
- Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Carolina Schinke
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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3
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Mohan M, Monge J, Shah N, Luan D, Forsberg M, Bhatlapenumarthi V, Balev M, Patwari A, Cheruvalath H, Bhutani D, Thanendrarajan S, Dhakal B, Zangari M, Al-Hadidi S, Cooper D, Lentzsch S, van Rhee F, D'Souza A, Szabo A, Schinke C, Chakraborty R. Teclistamab in relapsed refractory multiple myeloma: multi-institutional real-world study. Blood Cancer J 2024; 14:35. [PMID: 38443345 PMCID: PMC10914756 DOI: 10.1038/s41408-024-01003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 03/07/2024] Open
Abstract
The objective of our study was to report real-world data on the safety and efficacy of standard-of-care teclistamab in patients with relapsed/refractory multiple myeloma (MM). This is a multi-institutional retrospective cohort study and included all consecutive patients that received at least one dose of teclistamab up until August 2023. One hundred and ten patients were included, of whom, 86% had triple-class refractory disease, 76% penta-refractory disease, and 35% had prior exposure to B-cell maturation antigen (BCMA)-targeting therapies. The overall response rate (ORR) in our cohort was 62%, with a ≥ very good partial remission (VGPR) rate of 51%. The ORR in patients with and without prior BCMA-targeted therapies was 54% vs 67%, respectively (p = 0.23). At a median follow-up of 3.5 months (range, 0.39-10.92), the estimated 3 month and 6 month progression free survival (PFS) was 57% (95% CI, 48%, 68%) and 52% (95% CI, 42%, 64%) respectively. The incidence of cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) was 56% and 11% respectively, with grade ≥3 CRS and ICANS noted in 3.5% and 4.6% of patients respectively. 78 unique infections were diagnosed in 44 patients, with the incidence of all-grade and grade ≥3 infections being 40% vs 26% respectively. Primary prophylaxis with intravenous immunoglobulin (IVIG) was associated with a significantly lower infection risk on multivariate analysis (Hazard ratio [HR] 0.33; 95% CI 0.17, 0.64; p = 0.001).
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Affiliation(s)
- Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jorge Monge
- Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Nishi Shah
- Division of Hematological Malignancies, Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY, USA
| | - Danny Luan
- Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Mark Forsberg
- Division of Hematological Malignancies, Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY, USA
| | - Vineel Bhatlapenumarthi
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Metodi Balev
- Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Anannya Patwari
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Divaya Bhutani
- Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | | | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maurizio Zangari
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Samer Al-Hadidi
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Dennis Cooper
- Division of Hematological Malignancies, Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY, USA
| | - Suzanne Lentzsch
- Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Frits van Rhee
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carolina Schinke
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Rajshekhar Chakraborty
- Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
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4
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Hammons L, Haider S, Portuguese AJ, Banerjee R, Szabo A, Pasquini M, Chhabra S, Radhakrishnan S, Mohan M, Narra R, Dong J, Janz S, Shah NN, Hamadani M, D'Souza A, Hari P, Dhakal B. Chimeric antigen receptor and bispecific T-cell engager therapies in multiple myeloma patients with prior allogeneic transplantation. Br J Haematol 2024; 204:887-891. [PMID: 38054558 DOI: 10.1111/bjh.19244] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023]
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy and bispecific T-cell engagers (BsAb) have emerged as promising immunotherapeutic modalities in patients with relapsed and/or refractory multiple myeloma (RRMM). However, there is limited data on the safety and efficacy of CAR-T and BsAb therapies in MM patients with a prior history of allogeneic transplantation (allo-HCT). Thirty-three MM patients with prior allo-HCT received CAR-T (n = 24) or BsAb (n = 9) therapy. CAR-T therapy demonstrated an ORR of 92% (67% ≥ CR), and 73% were MRD negative. BsAb therapy resulted in an ORR of 44% (44% ≥ CR) and 44% MRD negative. Safety analysis showed grade ≥3 AEs in 92% of CAR-T and 56% of BsAb patients. Cytokine release syndrome (CRS) occurred in 83% of CAR-T and 78% of BsAb recipients, while immune effector cell-associated neurotoxicity syndrome (ICANS) was observed in three CAR-T patients. Infections of grade ≥3 were reported in 50% of CAR-T and 44% of BsAb recipients. No exacerbation of graft-versus-host disease occurred except in one BsAb recipient. CAR-T and BsAb therapies appear to be feasible, safe and provide deep and durable responses in MM patients with prior allo-HCT.
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Affiliation(s)
- Lindsay Hammons
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shabi Haider
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew J Portuguese
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Rahul Banerjee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Aniko Szabo
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marcelo Pasquini
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Sabarinath Radhakrishnan
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meera Mohan
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ravi Narra
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jing Dong
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Siegfried Janz
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nirav N Shah
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mehdi Hamadani
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anita D'Souza
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Parameswaran Hari
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Binod Dhakal
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Chhabra S, Jerkins JH, Monahan K, Szabo A, Shah NN, Abedin S, Runaas L, Fenske TS, Pasquini MC, Shaw BE, Drobyski WR, Saber W, D'Souza A, Dhakal B, Mohan M, Longo W, Hamadani M. Severity and organ distribution of chronic graft-versus-host disease with posttransplant cyclophosphamide-based versus methotrexate/calcineurin inhibitor-based allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2024; 59:373-379. [PMID: 38177221 DOI: 10.1038/s41409-023-02178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
The reduced risk of chronic graft-versus-host-disease (GVHD) with posttransplant cyclophosphamide (ptCy) in the setting of haploidentical related donor and more recently, with HLA-matched related and matched and mismatched unrelated donor allogeneic transplantation has been established. There is, however, paucity of data to show if ptCy impacts chronic GVHD pathogenesis, its phenotype and evolution after HCT regardless of the donor status. We examined the differences in chronic GVHD incidence and presentation in 314 consecutive patients after receiving their first allogeneic transplantation (HCT) using ptCy-based GVHD prophylaxis (ptCy-HCT; n = 120; including 95 with haploidentical related donor) versus conventional calcineurin inhibitor-based prophylaxis (CNI-MUD; n = 194) between 2012 and 2019. The 1-year cumulative incidence of all-grade chronic GVHD and moderate/severe chronic GVHD was 24% and 12%, respectively, after ptCy-HCT and 40% and 23% in the CNI-MUD recipients (p = 0.0003 and 0.007). Multivariable analysis confirmed that use of CNI-based GVHD prophylaxis and peripheral blood stem cell graft as the risk factors for chronic GVHD. The cumulative incidence of visceral (involving ≥1 of the following organs: liver, lungs, gastrointestinal tract, serous membranes) chronic GVHD was significantly higher with CNI-MUD vs. ptCy-HCT (27% vs. 15% at 1 year, p = 0.009). The incidence of moderate/severe visceral chronic GVHD was 20% in CNI-MUD group vs. 7.7% in the ptCy-HCT group at 1 year (p = 0.002). In addition, significantly fewer ptCy-HCT recipients developed severe chronic GVHD in ≥3 organs (0.8%) vs. 8.8% in the CNI-MUD group at 1-year posttransplant (p = 0.004). There was no significant different in relapse, non-relapse mortality, and relapse-free and overall survival between the two groups. Further investigation is needed to confirm that reduced risk and severity of chronic GVHD, less visceral organ distribution with ptCy-HCT leads to improved quality of life.
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Affiliation(s)
- Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
- Previously at Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James H Jerkins
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Previously at Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathleen Monahan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nirav N Shah
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sameem Abedin
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lyndsey Runaas
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy S Fenske
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcelo C Pasquini
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bronwen E Shaw
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William R Drobyski
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wael Saber
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Walter Longo
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.
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Hammons L, Szabo A, Janardan A, Bhatlapenumarthi V, Annyapu E, Dhakal B, Al Hadidi S, Radhakrishnan SV, Narra R, Bhutani D, Thanendrarajan S, Janz S, Zangari M, Lentzsch S, Van Rhee F, Crescencio JCR, D'Souza A, Chakraborty R, Mohan M, Schinke C. The changing spectrum of infection with BCMA and GPRC5D targeting bispecific antibody (bsAb) therapy in patients with relapsed refractory multiple myeloma. Haematologica 2024; 109:906-914. [PMID: 37646658 PMCID: PMC10905074 DOI: 10.3324/haematol.2023.283590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023] Open
Abstract
There is a paucity of granular data on infection risk with B-cell maturation antigen (BMCA) and GPRC5D bispecific antibodies (bsAb) in relapsed/refractory multiple myeloma (RRMM). The aim of our multi-institutional study was to characterize the incidence, etiologies, and risk factors of infections from the start of therapy to the last follow-up or 90 days after study exit. A total of 66 patients received BCMA bsAb monotherapy, 15 GPRC5D bsAb monotherapy, and 15 GPRC5D bsAb combination therapy with daratumumab and/or pomalidomide. While the infection rate per 100 days was 0.57 for BCMA bsAb, it was 0.62 for GPRC5D bsAb combination and 0.13 for GPRC5D bsAb monotherapy; P=0.05. The proportion of infections that were grade ≥3 was higher in the BCMA bsAb group compared to the GPRC5D groups (58% vs. 36%; P=0.04). Grade 5 events were observed in 8% (n=8) of the patients, all treated with BCMA bsAb. The 9 month cumulative incidence of any grade of infection was similar in the BCMA and GPRC5D-combination groups (57% and 62%) and significantly higher than in the GPRC5D-mono group (16%); P=0.012. The cumulative incidence of grade ≥3 infections was highest in the BCMA group reaching 54% at 18 months; P=0.06. Multivariate analysis showed that BCMA bsAb therapy or GPRC5D combination therapy, history of previous infections, baseline lymphopenia, and baseline hypogammaglobulinemia were significantly associated with a higher risk of grade ≥3 infections. Our results indicate that BCMA bsAb and GPRC5D-combination therapies in RRMM are associated with higher cumulative incidence of infection and grade ≥3 infection compared to GPRC5D bsAb mono.
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Affiliation(s)
- Lindsay Hammons
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Aniko Szabo
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | | | - Vineel Bhatlapenumarthi
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Evanka Annyapu
- Medical College of Wisconsin Medical School, Milwaukee, WI
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Samer Al Hadidi
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR
| | | | - Ravi Narra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Divaya Bhutani
- Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, NY
| | | | - Siegfried Janz
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Maurizio Zangari
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR
| | - Suzanne Lentzsch
- Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, NY
| | - Frits Van Rhee
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR
| | - Juan Carlos Rico Crescencio
- Internal Medicine, Division of Infection Disease, University of Arkansas for Medical Science, Little Rock, AR
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Rajshekhar Chakraborty
- Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, NY
| | - Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Carolina Schinke
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR.
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7
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Mohan M, Szabo A, Patwari A, Esselmann J, Patel T, Bachu R, Rein LE, Janardan A, Bhatlapenumarthi V, Annyapu E, Skoog C, Goff A, Hadidi SA, Radhakrishnan SV, Thanendrarajan S, Zangari M, Shah N, van Rhee F, Dhakal B, Hamadani M, D'Souza A, Schinke C. Autologous stem cell boost improves persistent immune effector cell associated hematotoxicity following BCMA directed chimeric antigen receptor T (CAR T) cell therapy in multiple myeloma. Bone Marrow Transplant 2024:10.1038/s41409-024-02233-2. [PMID: 38361116 DOI: 10.1038/s41409-024-02233-2] [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] [Received: 12/13/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
Persistent Immune Effector Cell Associated Hematotoxicity (ICAHT) is a significant side effect of BCMA CAR T-Cell therapy in patients with relapsed multiple myeloma (MM). The use of stem cell boosts in ICAHT has been described, however studies have been limited by small patient numbers and short follow up. Herein, we report on our multi-institutional experience of ICAHT, defined by an absolute neutrophil count (ANC) of ≤ 1000, thrombocytopenia with a platelet count ≤ 50,000 or/and anemia as hemoglobin (hgb) ≤9 g/dL, in patients who received BCMA CAR T therapy, and the effects of subsequent stem cell boost on hematopoietic reconstitution and clinical outcome. In this study, ICAHT was observed in 60% (n = 61/101) of patients at D + 21, and risk factors for its development included history of a prior ASCT, higher number of prior lines of therapy, a decreased platelet count prior to lymphodepletion and history of ICANS. 28% of patients with ICAHT received a stem cell boost at a median of 116 days due to profound and prolonged cytopenias often requiring ongoing transfusion support. Stem cell boost significantly improved cytopenias at 3 and 6 months follow up without any adverse effects on PFS and OS, underscoring the safety of this procedure.
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Affiliation(s)
- Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Aniko Szabo
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anannya Patwari
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jean Esselmann
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tanvi Patel
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Ramya Bachu
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Lisa E Rein
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
| | | | - Vineel Bhatlapenumarthi
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Evanka Annyapu
- Medical College of Wisconsin Medical School, Milwaukee, WI, USA
| | - Catherine Skoog
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Areyl Goff
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Samer Al Hadidi
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
| | | | | | - Maurizio Zangari
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Nirav Shah
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Frits van Rhee
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carolina Schinke
- Myeloma Center, University of Arkansas for Medical Science, Little Rock, AR, USA
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8
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Neupane K, Fortuna GG, Dahal R, Schmidt T, Fonseca R, Chakraborty R, Koehn KA, Mohan M, Mian H, Costa LJ, Sborov D, Mohyuddin GR. Alterations in chromosome 1q in multiple myeloma randomized clinical trials: a systematic review. Blood Cancer J 2024; 14:20. [PMID: 38272897 PMCID: PMC10810902 DOI: 10.1038/s41408-024-00985-0] [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: 09/10/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
Extra copies of chromosome 1q21 (+1q: gain = 3 copies, amp >= 4 copies) are associated with worse outcomes in multiple myeloma (MM). This systematic review assesses the current reporting trends of +1q, the efficacy of existing regimens on +1q, and its prognostic implications in MM randomized controlled trials (RCTs). Pubmed, Embase and Cochrane Registry of RCTs were searched from January 2012 to December 2022. Only MM RCTs were included. A total of 124 RCTs were included, of which 29 (23%) studies reported on +1q. Among them, 10% defined thresholds for +1q, 14% reported survival data separately for gain and amp, and 79% considered +1q a high-risk cytogenetic abnormality. Amongst RCTs that met the primary endpoint showing improvement in progression free survival (PFS), lenalidomide maintenance (Myeloma XI), selinexor (BOSTON), and isatuximab (IKEMA and ICARIA) were shown to improve PFS for patients with evidence of +1q. Some additional RCT's such as Myeloma XI+ (carfilzomib), ELOQUENT-3 (elotuzumab), and HOVON-65/GMMG-HD4 (bortezomib) met their endpoint showing improvement in PFS and also showed improvement in PFS in the +1q cohort, although the confidence interval crossed 1. All six studies that reported HR for +1q patients vs. without (across both arms) showed worse OS and PFS for +1q. There is considerable heterogeneity in the reporting of +1q. All interventions that have shown to be successful in RCTs and have clearly reported on the +1q subgroup have shown concordant direction of results and benefit of the applied intervention. A more standardized approach to reporting this abnormality is needed.
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Affiliation(s)
- Karun Neupane
- Department of Internal Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, USA
| | - Gliceida Galarza Fortuna
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Riyasha Dahal
- Department of Internal Medicine, Universal College of Medical Sciences, Siddharthanagar, Nepal
| | - Timothy Schmidt
- Department of Hematology-Oncology, University of Wisconsin, Madison, WI, USA
| | - Rafael Fonseca
- Department of Hematology-Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Rajshekhar Chakraborty
- Department of Hematology and Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Kelly Ann Koehn
- Department of Hematology and Oncology, Chub O'Reilly Cancer Center, Springfield, MO, USA
| | - Meera Mohan
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, US
| | - Hira Mian
- Department of Hematology and Oncology, McMaster University, Hamilton, ON, Canada
| | - Luciano J Costa
- Department of Hematology and Oncology, O'Neal Cancer Center, University of Alabama, Birmingham, AL, USA
| | - Douglas Sborov
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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9
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Mohan M, Kothari A, Verhagen N, Shreenivas A, Radhakrishnan SV, Dhakal B, Figueroa-Castro C, Chhabra S, Janz S, Pasquini M, Hamadani M, Szabo A, D'Souza A. Blood and marrow transplant within 4 weeks of SARS-CoV-2 infection is associated with increased risk of mortality: a National COVID Cohort Collaborative (N3C) Study. Bone Marrow Transplant 2024; 59:121-124. [PMID: 37803198 DOI: 10.1038/s41409-023-02096-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Anai Kothari
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Aditya Shreenivas
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carlos Figueroa-Castro
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Siegfried Janz
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcello Pasquini
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute of Health and Safety, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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10
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Mohan M, Chakraborty R, Bal S, Nellore A, Baljevic M, D’Souza A, Pappas PG, Berdeja JG, Callander N, Costa LJ. Recommendations on prevention of infections during chimeric antigen receptor T-cell and bispecific antibody therapy in multiple myeloma. Br J Haematol 2023; 203:736-746. [PMID: 37287117 PMCID: PMC10700672 DOI: 10.1111/bjh.18909] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 03/14/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023]
Abstract
Chimeric antigen receptor T (CAR T) cell and bispecific antibody therapies have shown unprecedented efficacy in heavily pretreated patients with multiple myeloma (MM). However, their use is associated with a significant risk of severe infections, which can be attributed to various factors such as hypogammaglobulinemia, neutropenia, lymphopenia, T-cell exhaustion, cytokine-release syndrome and immune-effector cell-associated neurotoxicity syndrome. As these therapies have been recently approved by regulatory agencies, it is crucial to establish practical guidelines for infection monitoring and prevention until robust data from prospective clinical trials become available. To address this issue, a panel of experienced investigators from the Academic Consortium to Overcome Multiple Myeloma through Innovative Trials (COMMIT) developed consensus recommendations for mitigating infections associated with CAR T-cell and bispecific antibody therapies in MM patients.
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Affiliation(s)
- Meera Mohan
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - Rajshekhar Chakraborty
- Multiple Myeloma and Amyloidosis Program, Columbia University, Herbert Irving Comprehensive Cancer Center, NY, U.S.A
| | - Susan Bal
- Division of Hematology and Medical Oncology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - Anoma Nellore
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - Muhamed Baljevic
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, TN, U.S.A
| | - Anita D’Souza
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - Peter G Pappas
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | | | | | - Luciano J. Costa
- Division of Hematology and Medical Oncology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
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11
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Surati U, Mohan M, Jayakumar S, Verma A, Niranjan SK. Genome-wide in silico analysis leads to identification of deleterious L290V mutation in RBBP5 gene in Bos indicus. Anim Biotechnol 2023; 34:4851-4859. [PMID: 37051916 DOI: 10.1080/10495398.2023.2199502] [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] [Indexed: 04/14/2023]
Abstract
Genome-wide deleterious mutations were identified in zebu cattle (Bos indicus) using in silico approach. The ddRAD sequence data of Sahiwal cattle were annotated and aligned with the cattle reference genome (ARS-UCD1.2). A total of 279,383 SNPs were identified at Read Depth10, which were further filtered to 692 missense SNPs. These SNPs were further analyzed, for functional consequences, by using Variant Effect Predictor, PolyPhen, PROVEAN, and PANTHER tools. A total of 18 SNPs, were finally identified as deleterious, and among these, 12 SNPs were mapped on nine different genes. ERRAT, ProSA-web, Project HOPE, TM-Align, and YASSARA tools, further confirmed the protein malfunctioning of one missense (L290V) mutation of Retinoblastoma binding protein-5 (RBBP5) gene, transcribing a cell cycle regulatory protein and associated with Retinoblastoma in human. This derived bioinformatics pipeline may be useful for preliminarily identifying the deleterious DNA mutations in livestock, specifically in absence of any genetic disease records.
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Affiliation(s)
- Utsav Surati
- ICAR-National Bureau of Animal Genetic Resources, Karnal, India
- ICAR-National Dairy Research Institute, Karnal, India
| | - M Mohan
- ICAR-National Bureau of Animal Genetic Resources, Karnal, India
- ICAR-National Dairy Research Institute, Karnal, India
| | - S Jayakumar
- ICAR-Directorate of Poultry Research, Hyderabad, India
| | - Archana Verma
- ICAR-National Dairy Research Institute, Karnal, India
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12
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Chakraborty R, Bhutani D, Maurer MS, Mohan M, Lentzsch S, D'Souza A. Safety and efficacy of teclistamab in systemic immunoglobulin light chain amyloidosis. Blood Cancer J 2023; 13:172. [PMID: 38012151 PMCID: PMC10682473 DOI: 10.1038/s41408-023-00950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
| | - Divaya Bhutani
- Columbia University Irving Medical Center, New York, NY, USA
| | - Mathew S Maurer
- Columbia University Irving Medical Center, New York, NY, USA
| | - Meera Mohan
- Medical College of Wisconsin, Milwaukee, WI, USA
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13
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Kleman A, Singavi A, Pommert L, Mathison AJ, Hari P, Dhakal B, Mohan M, Janz S, Knight JM, Shah MV, Schinke C, Burns R, Steinhardt GF, Rao S, Carlson K. A timeline of genetic variant enrichment: from multiple myeloma diagnosis to myeloma-associated myeloid malignancy. Blood Adv 2023; 7:5549-5553. [PMID: 36724511 PMCID: PMC10514068 DOI: 10.1182/bloodadvances.2022008953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Affiliation(s)
- Ariel Kleman
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Arun Singavi
- Virginia G. Piper Cancer Care Network, Scottsdale, AZ
| | - Lauren Pommert
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Angela J. Mathison
- Mellowes Center for Genomic Sciences and Precision Medicine, Milwaukee, WI
- Division of Research, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Parameswaran Hari
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Iovance Biotherapeutics, San Carlos, CA
| | - Binod Dhakal
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Meera Mohan
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Siegfried Janz
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer M. Knight
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Departments of Psychiatry and Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, WI
| | - Mithun V. Shah
- Division of Hematology, Mayo Clinic Rochester Minnesota, Rochester, MN
| | - Carolina Schinke
- Myeloma Center, Divsion of Hematology Oncology, University of Arkansas, Fayetteville, AR
| | | | | | - Sridhar Rao
- Division of Hematology, Department of Pediatrics, Oncology, and Transplantation, Medical College of Wisconsin, Milwaukee, WI
- Blood Research Institute, Versiti, Waukesha, WI
| | - Karen Carlson
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Blood Research Institute, Versiti, Waukesha, WI
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14
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Mohan M, Gong Z, Ashby TC, Al Hadidi S, Thanendrarajan S, Schinke C, Alapat D, Shaughnessy JD, Zhan F, van Rhee F, Sawyer JR, Tian E, Zangari M. Concomitant deletion of the short arm (del(1p13.3)) and amplification or gain (1q21) of chromosome 1 by fluorescence in situ hybridization are associated with a poor clinical outcome in multiple myeloma. Cancer 2023; 129:2491-2498. [PMID: 37282609 DOI: 10.1002/cncr.34895] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Chromosome 1 abnormalities in multiple myeloma (MM) are increasingly recognized as high risk-defining features. The authors report the prognostic value of del(1p13.3) by fluorescence in situ hybridization (FISH) at enrollment in subjects treated on total therapy clinical trials 2-6. METHODS FISH probes were generated from specific BAC DNA clones for the AHCYL1 gene locus (1p13.3) and the CKS1B locus (1q21). RESULTS A total of 1133 patients were included in this analysis. Although del(1p13.3) was detected in 220 (19.4%) patients, 1q21gain or 1q21amp were observed in 300 (26.5%) and 150 (13.2%) patients, respectively. Concomitant del(1p13.3) with 1q21 gain or amp was observed in 65 (5.7%) and 29 (2.5%) patients, respectively. There was enrichment of high-risk features such as International Staging System (ISS) stage 3 disease and gene expression profiling (GEP)70 high risk (HR) in the group with del(1p13.3). Presence of del(1p13.3) confers inferior progression-free survival (PFS) and overall survival (OS). On multivariate analysis, the presence of ISS stage 3 disease, GEP70 HR, 1q21gain, and 1q21amp were independent predictors of PFS or OS. CONCLUSIONS The PFS and OS of patients with combined abnormalities of del (1p13.3)/1q21gain or amp was significantly worse compared to del(1p13.3) alone and 1q21gain or 1q21 amp alone, which identifies a subset of patients with poor clinical outcomes.
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Affiliation(s)
- Meera Mohan
- Clinical Cancer Center, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zimu Gong
- Baylor Scott & White Charles A. Sammons Cancer Center, Houston, Texas, USA
| | - Timothy Cody Ashby
- Myeloma Center, Winthrop P. Rockefeller Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Samer Al Hadidi
- Myeloma Center, Winthrop P. Rockefeller Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sharmilan Thanendrarajan
- Myeloma Center, Winthrop P. Rockefeller Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Carolina Schinke
- Myeloma Center, Winthrop P. Rockefeller Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Daisy Alapat
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John D Shaughnessy
- Myeloma Center, Winthrop P. Rockefeller Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Fenghuang Zhan
- Myeloma Center, Winthrop P. Rockefeller Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Frits van Rhee
- Myeloma Center, Winthrop P. Rockefeller Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jeffery R Sawyer
- Myeloma Center, Winthrop P. Rockefeller Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Erming Tian
- Myeloma Center, Winthrop P. Rockefeller Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Maurizio Zangari
- Myeloma Center, Winthrop P. Rockefeller Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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15
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Mohan M, Janz S, Brazauskas R, Dwinell MB, Teng BQ, Yun G, Dong J, Pasquini MC, Giralt S, Landau H, Stadtmauer E, Krishnan A, D'Souza A. Increased CXCL10 is seen at 1-year after autologous hematopoietic cell transplantation in multiple myeloma patients on maintenance lenalidomide therapy. Bone Marrow Transplant 2023; 58:953-955. [PMID: 37149674 PMCID: PMC10555486 DOI: 10.1038/s41409-023-02004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Siegfried Janz
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ruta Brazauskas
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael B Dwinell
- Center for Immunology, Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bi Qing Teng
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Grant Yun
- Medical College of Wisconsin Medical School, Milwaukee, WI, USA
| | - Jing Dong
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcelo C Pasquini
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sergio Giralt
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather Landau
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edward Stadtmauer
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amrita Krishnan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, CA, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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16
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Mian A, Naqvi SAA, Ayaz A, Husnain M, Aljama MA, Mohyuddin GR, Koehn K, Mohan M, Bin Riaz I, Chakraborty R. Incidence of second primary malignancies in patients with multiple myeloma receiving anti-CD38 monoclonal antibodies: A systematic review and meta-analysis. Leuk Res 2023; 131:107324. [PMID: 37285641 DOI: 10.1016/j.leukres.2023.107324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
Anti-CD38 monoclonal antibodies (mAbs) are commonly used for treating newly diagnosed and relapsed/refractory (r/r) multiple myeloma (MM). However, concerns have been raised about the occurrence of second primary malignancies (SPMs) in patients receiving anti-CD38 mAbs. Assessing the safety data for rare adverse events like SPMs is challenging because individual clinical trials are typically focused on the primary endpoint. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) published between January 2005 and April 2022, including patients with newly diagnosed or r/r MM. Our aim was to compare SPM rate with the use of anti-CD38 mAb-based regimens with other anti-myeloma regimens. After a median follow-up of 35.3 months (range: 8.2-56.2), we found that exposure to anti-CD38 mAbs was associated with an increased risk of developing SPMs compared to the control group (6.8% vs. 5.2%; Peto odds ratio [OR]: 1.53 [95% confidence interval (CI): 1.20-1.95]; I2= 0%, p-value for heterogeneity= 0.44). This increased risk was primarily driven by non-melanoma cutaneous cancers (92 vs. 47; Peto OR: 1.77 [95% CI: 1.25-2.51]; I2 = 0%, p-value for heterogeneity = 0.54). However, there was no significant difference in the incidence of solid tumors (including malignant melanoma) (OR: 1.28 [95% CI: 0.85-1.95]) or hematologic SPMs (OR: 1.86; [95% CI: 0.81-4.27]). In conclusion, the use of anti-CD38 mAb-based combination regimens is associated with a higher risk of non-invasive cutaneous SPMs, but not solid tumors or hematologic SPMs. The increased occurrence of non-invasive cutaneous SPMs may be due to enhanced monitoring resulting from longer treatment duration with anti-CD38 mAbs.
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Affiliation(s)
- Agrima Mian
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ahsan Ayaz
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Mohammed A Aljama
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Kelly Koehn
- Department of Hematological Malignancies, Kansas University Medical Center, Kansas City, KS, USA
| | - Meera Mohan
- Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Irbaz Bin Riaz
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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17
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Hashmi H, Atrash S, Jain J, Khasawneh G, Mohan M, Mahmoudjafari Z, Cui W, McGuirk J, Shune L, Ahmed N, Abdallah AO. Daratumumab, pomalidomide, and dexamethasone (DPd) followed by high dose chemotherapy-Autologous Stem Cell Transplantation leads to superior outcomes when compared to DPd-alone for patients with Relapsed Refractory Multiple Myeloma. Transplant Cell Ther 2023; 29:262.e1-262.e6. [PMID: 36682468 DOI: 10.1016/j.jtct.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/26/2022] [Accepted: 01/15/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES While the role of autologous stem cell transplant (ASCT) in the first line therapy for newly diagnosed multiple myeloma is well established, efficacy of ASCT for patients with relapsed refractory multiple myeloma (RRMM) in the era of novel therapeutic agents remains unknown. In this single center retrospective analysis, we evaluated and compared the efficacy and safety outcomes of patients with RRMM treated with daratumumab pomalidomide dexamethasone (DPd) alone versus (vs) DPd followed by ASCT. METHODS A total of 83 patients with RRMM who were treated with and achieved at least partial response (PR) with DPd were evaluated by electronic medical records. All patients who responded to DPd and were deemed eligible for ASCT proceeded with high dose melphalan followed by autologous stem cell infusion (DPd + ASCT group). Remaining patients continued DPd until disease progression or intolerable toxicities (DPd-alone group). Responses were evaluated using the International Myeloma Working Group response criteria and toxicities were graded using National Cancer Institute Common Terminology Criteria for Adverse Events. Patient and disease characteristics, as well as efficacy and safety outcomes were summarized using descriptive statistics. Kaplan-Meier analyses were used to estimate progression-free survival (PFS) and overall survival (OS). RESULTS A total of 21/83 (25%) patients with RRMM who achieved at least PR to DPd underwent ASCT (DPd + ASCT group) while the remaining 62/83 (75%) continued DPd without ASCT (DPd-alone group). For the entire patient population, median age was 66 years (42-81), 49 (59%) patients were male, 54 (65%) patients had IgG isotype, 21 (25%) patients had R-ISS stage III disease, 51 (61%) patients had high-risk cytogenetics, and 17 (20%) patients had extramedullary disease. Patient age, disease stage, cytogenetic risk profile were well balanced between two groups. A stringent complete response was seen in 10 (16%) and 12 (57%) patients in the DPd-alone and DPd + AST groups, respectively. Median PFS was 17.5 months in the DPd-alone vs 42.2 months (p=0.006) in the DPd + ASCT group. Median OS was 38.1 months in the DPd-alone group vs not reached in the DPD + ASCT group (p=0.009). The most common grade 3 or 4 treatment-related adverse events (TRAE) were myelosuppression and gastrointestinal toxicities, more commonly seen in the DPd + ASCT group. No treatment-related mortalities were observed in either group. CONCLUSION Patients with RRMM who responded to DPd and underwent HDT-ASCT demonstrated superior depth and duration of remission compared to those who received DPd-alone. Although DPd followed by ASCT is associated with more cytopenias and gastrointestinal toxicities, this treatment appears to be overall safe for patients with RRMM.
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Affiliation(s)
- Hamza Hashmi
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, US; US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, US.
| | - Shebli Atrash
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, US; US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, US
| | - Jayanshu Jain
- University of Kansas Medical Center, Westwood, KS, US
| | - Ghena Khasawneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Meera Mohan
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, US; US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, US
| | - Zahra Mahmoudjafari
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, US; US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, US
| | - Wei Cui
- University of Kansas Medical Center, Westwood, KS, US; US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, US
| | - Joseph McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, US
| | - Leyla Shune
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, US; US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, US
| | - Nausheen Ahmed
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, US; US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, US
| | - Al-Ola Abdallah
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, US; US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, US
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18
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Al Hadidi S, Szabo A, Esselmann J, Hammons L, Hussain M, Ogunsesan Y, Thalambedu N, Khan F, Sethi J, Janardan A, Radhakrishnan SV, Thanendrarajan S, Schinke C, Dhakal B, Janz S, Chhabra S, D'Souza A, Zangari M, van Rhee F, Mohan M. Clinical outcome of patients with relapsed refractory multiple myeloma listed for BCMA directed commercial CAR-T therapy. Bone Marrow Transplant 2023; 58:443-445. [PMID: 36550200 DOI: 10.1038/s41409-022-01905-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Samer Al Hadidi
- Myeloma Center, Division of Hematology Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Aniko Szabo
- Bone Marrow Transplant Service, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jean Esselmann
- Bone Marrow Transplant Service, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lindsay Hammons
- Bone Marrow Transplant Service, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Munawwar Hussain
- Myeloma Center, Division of Hematology Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yetunde Ogunsesan
- Myeloma Center, Division of Hematology Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nishanth Thalambedu
- Myeloma Center, Division of Hematology Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Fatima Khan
- Myeloma Center, Division of Hematology Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jaskirat Sethi
- Myeloma Center, Division of Hematology Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Abhishek Janardan
- Bone Marrow Transplant Service, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Sharmilan Thanendrarajan
- Myeloma Center, Division of Hematology Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Carolina Schinke
- Myeloma Center, Division of Hematology Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Binod Dhakal
- Bone Marrow Transplant Service, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Siegfried Janz
- Bone Marrow Transplant Service, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Rochester, AZ, USA
| | - Anita D'Souza
- Bone Marrow Transplant Service, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maurizio Zangari
- Myeloma Center, Division of Hematology Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Frits van Rhee
- Myeloma Center, Division of Hematology Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Meera Mohan
- Bone Marrow Transplant Service, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
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19
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Abdallah AO, Mahmoudjafari Z, Ahmed N, Cui W, Shune L, McGuirk J, Mohan M, Mohyuddin GR, Afrough A, Alkharabsheh O, Atrash S. Clinical efficacy of retreatment of daratumumab-based therapy (D2) in daratumumab-refractory multiple myeloma. Eur J Haematol 2023; 110:626-632. [PMID: 36752328 DOI: 10.1111/ejh.13942] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
Daratumumab demonstrates activity as a single agent and in combination with either immunomodulatory agents (IMiDs) or proteasome inhibitors (PIs) in relapsed refractory multiple myeloma (RRMM). However, little is known about the benefit of daratumumab retreatment in daratumumab-refractory MM. This study aimed to analyze the clinical efficacy of daratumumab-based retreatment (D2) in patients who are daratumumab refractory MM. Retrospectively, we identified 43 RRMM patients from a single-center database review. The median age was 65 years, 42% patients had high-risk cytogenetics, and 23% had an extramedullary disease, while the median time between D2 and prior daratumumab was 1 (0.25-39) month. All D2 patients received combination therapy with either pomalidomide, carfilzomib, bortezomib, or lenalidomide. The response rate, median progression-free, and overall survival were 49%, 7.97 and 32.6 months, respectively. Our study raises the possibility of re-utilizing daratumumab in combination with different classes of anti-myeloma drugs to generate responses in RRMM patients who are daratumumab-refractory.
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Affiliation(s)
- Al-Ola Abdallah
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA.,US Myeloma Innovations Research Collaborative (USMIRC), Westwood, Kansas, USA
| | - Zahra Mahmoudjafari
- US Myeloma Innovations Research Collaborative (USMIRC), Westwood, Kansas, USA.,University of Kansas Medical Center, Westwood, Kansas, USA
| | - Nausheen Ahmed
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA.,US Myeloma Innovations Research Collaborative (USMIRC), Westwood, Kansas, USA
| | - Wei Cui
- US Myeloma Innovations Research Collaborative (USMIRC), Westwood, Kansas, USA.,University of Kansas Medical Center, Westwood, Kansas, USA
| | - Leyla Shune
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA.,US Myeloma Innovations Research Collaborative (USMIRC), Westwood, Kansas, USA
| | - Joseph McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Meera Mohan
- US Myeloma Innovations Research Collaborative (USMIRC), Westwood, Kansas, USA.,Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematologic Malignancies, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Aimaz Afrough
- US Myeloma Innovations Research Collaborative (USMIRC), Westwood, Kansas, USA.,Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Omar Alkharabsheh
- US Myeloma Innovations Research Collaborative (USMIRC), Westwood, Kansas, USA.,Division of Hematology/Oncology, University of South Alabama, Mobile, Alabama, USA
| | - Shebli Atrash
- US Myeloma Innovations Research Collaborative (USMIRC), Westwood, Kansas, USA.,Division of Hematology, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina, USA
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20
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Dupatne P, Venkatesan T, Navik O, Mohan M, Venugopal KM, . B, Linga V, Lalitha Y, Sivakumar G, Ashwini M. Cross-resistance and biochemical mechanism in an insecticide-resistant population of Trichogramma chilonis Ishii (Hymenoptera: Trichogrammatidae) and its parasitizing efficiency against invasive fall armyworm Spodoptera frugiperda (J.E. Smith). CURR SCI INDIA 2023. [DOI: 10.18520/cs/v124/i1/115-122] [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: 01/25/2023]
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21
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Gaur S, Kalani P, Mohan M. Harmonic-to-noise ratio as speech biomarker for fatigue: K-nearest neighbour machine learning algorithm. Med J Armed Forces India 2023. [DOI: 10.1016/j.mjafi.2022.12.001] [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: 01/17/2023] Open
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22
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Atieh T, Atrash S, Ahmed N, Mohan M, Cui W, Shune L, Hajjar S, Mahmoudjafari Z, Quick J, Wishna A, Riffel J, McGuirk J, Mohyuddin GR, Abdallah AO. Belantamab in Combination with Dexamethasone in Patients with Triple-class Relapsed/Refractory Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2022; 22:912-919. [PMID: 36127271 DOI: 10.1016/j.clml.2022.08.003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/26/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Triple-class relapsed/refractory multiple myeloma (RRMM) has a poor prognosis. This study analyzed the clinical outcomes of Belantamab mafadotin in combination with dexamethasone (Bd) in triple-class RRMM. METHODS We identified 35 patients with triple-class RRMM who received Bd at the University of Kansas from October 2019 to November 2021. RESULTS The median age was 66 years (42-85) and the median prior lines of therapy was 5 (3-15). Nineteen (54%) patients had R-ISS stage III disease, 15 (43%) patients had high-risk cytogenetics, and 15 patients (43%) had extramedullary disease (EMD). Eight patients received prior BCMA-targeted therapy. Overall response rate (ORR) was 43%, with 23% achieving very good partial response and better. At a median follow up of 10.7 months, the median progression-free survival and survival were 4.9 and 10.7 months, respectively. The most common adverse event was keratopathy, which occurred in 30 (86%) patients. Twenty-four patients required dose reduction or delay due to keratopathy. Other common toxicities included anemia (83%), thrombocytopenia (80%), neutropenia (34%), and elevated liver function tests (51%). CONCLUSION Our analysis shows Bd has good activity in triple-class RRMM. Keratopathy remains a challenging AE and the leading cause of dose reduction, delay and treatment cessation.
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Affiliation(s)
- Tahani Atieh
- University of Kansas Medical Center, Kansas City, KA.
| | - Shebli Atrash
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; US Myeloma Research Consortium (USMRC, Kansas City, KA
| | - Nausheen Ahmed
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KA; US Myeloma Research Consortium (USMRC, Kansas City, KA
| | - Meera Mohan
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI; US Myeloma Research Consortium (USMRC, Kansas City, KA
| | - Wei Cui
- Division of Pathology & Laboratory Medicine, University of Kansas Medical Center, Kansas City, KA; US Myeloma Research Consortium (USMRC, Kansas City, KA
| | - Leyla Shune
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KA; US Myeloma Research Consortium (USMRC, Kansas City, KA
| | - Susana Hajjar
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; US Myeloma Research Consortium (USMRC, Kansas City, KA
| | - Zahra Mahmoudjafari
- University of Kansas Medical Center, Kansas City, KA; US Myeloma Research Consortium (USMRC, Kansas City, KA
| | - Julie Quick
- Division of Ophthalmology, University of Kansas Medical Center, Kansas City, KA
| | - Anne Wishna
- Division of Ophthalmology, University of Kansas Medical Center, Kansas City, KA
| | - Justin Riffel
- Division of Ophthalmology, University of Kansas Medical Center, Kansas City, KA
| | - Joseph McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KA
| | - Ghulam Rehman Mohyuddin
- Division of Hematology & Hematologic Malignancies, University of Utah, Salt Lake City, UT; US Myeloma Research Consortium (USMRC, Kansas City, KA
| | - Al-Ola Abdallah
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KA; US Myeloma Research Consortium (USMRC, Kansas City, KA
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23
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Mohan M, Rein LE, Thalambedu N, Ogunsesan Y, Hussain M, Sethi J, Khan F, Gundarlapalli S, Yarlagadda L, Dhakal B, Price M, Shirey M, Warner D, Thanendrarajan S, Janz S, Radhakrishnan SV, Al Hadidi S, Szabo A, D'Souza A, Zangari M, van Rhee F, Chhabra S, Schinke C. Corneal toxicity with belantamab mafodotin: Multi-institutional real-life experience. Am J Hematol 2022; 97:E451-E453. [PMID: 36097868 DOI: 10.1002/ajh.26728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/11/2022] [Accepted: 09/09/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Meera Mohan
- Division of Hematology/Oncology, Medical College of Wisconsin, Froedtert Clinical Cancer Center, Milwaukee, Wisconsin, USA
| | - Lisa E Rein
- Division of Hematology/Oncology, Medical College of Wisconsin, Froedtert Clinical Cancer Center, Milwaukee, Wisconsin, USA
| | - Nishanth Thalambedu
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Yetunde Ogunsesan
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Munawwar Hussain
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jaskirat Sethi
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Fatima Khan
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sravani Gundarlapalli
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lakshmi Yarlagadda
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Binod Dhakal
- Division of Hematology/Oncology, Medical College of Wisconsin, Froedtert Clinical Cancer Center, Milwaukee, Wisconsin, USA
| | - Mary Price
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Megan Shirey
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Davie Warner
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sharmilan Thanendrarajan
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Siegfried Janz
- Division of Hematology/Oncology, Medical College of Wisconsin, Froedtert Clinical Cancer Center, Milwaukee, Wisconsin, USA
| | | | - Samer Al Hadidi
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Aniko Szabo
- Division of Hematology/Oncology, Medical College of Wisconsin, Froedtert Clinical Cancer Center, Milwaukee, Wisconsin, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Medical College of Wisconsin, Froedtert Clinical Cancer Center, Milwaukee, Wisconsin, USA
| | - Maurizio Zangari
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Frits van Rhee
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Medical College of Wisconsin, Froedtert Clinical Cancer Center, Milwaukee, Wisconsin, USA
| | - Carolina Schinke
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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24
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Hammons LR, Szabo A, Janardan A, Dhakal B, Chhabra S, D’Souza A, Mohan M. Kinetics of Humoral Immunodeficiency With Bispecific Antibody Therapy in Relapsed Refractory Multiple Myeloma. JAMA Netw Open 2022; 5:e2238961. [PMID: 36306135 PMCID: PMC9617177 DOI: 10.1001/jamanetworkopen.2022.38961] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This case series describes the kinetics of humoral deficiency in patients with relapsed refractory multiple myeloma treated with bispecific antibodies, the infectious complications, and response to COVID-19 immunization.
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Affiliation(s)
- Lindsay R. Hammons
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee
| | - Aniko Szabo
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee
| | - Abhishek Janardan
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee
| | - Binod Dhakal
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee
| | - Saurabh Chhabra
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee
| | - Anita D’Souza
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee
| | - Meera Mohan
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee
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25
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Dweik A, Dweik H, Mian H, Mohan M, Schinke C, Al Hadidi S. Gender disparities in multiple myeloma publications. EJHaem 2022; 3:966-969. [PMID: 36051049 PMCID: PMC9422002 DOI: 10.1002/jha2.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Gender disparities exist in academia and are disproportionately affecting females. We conducted a cross-sectional study to analyze gender disparities in multiple myeloma (MM) publications. A total of 679 publications with 8898 authorships were analyzed. The mean number of authors for females vs. males, per publication, was 4.4 and 8.7, respectively. Females constituted a third of the total authors. Female first authors, corresponding authors, and last/senior authors were 34%, 21%, and 18%, respectively. Note that, 17% of authors of clinical trial publications were females. Gender disparities in MM publications exist and are more obvious in the last/corresponding authorship. Efforts should be made to identify factors that contribute to these disparities and work to resolve them.
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Affiliation(s)
- Aala Dweik
- Department of Medicine, Faculty of MedicineUniversity of JordanAmmanJordan
| | - Hadeel Dweik
- Department of Medicine, Faculty of MedicineUniversity of JordanAmmanJordan
| | - Hira Mian
- Department of OncologyMcMaster UniversityHamiltonCanada
| | - Meera Mohan
- Department of Internal MedicineDivision of Hematology and OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Carolina Schinke
- Department of Hematology and Oncology, Myeloma CenterWinthrop P. Rockefeller Cancer InstituteUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Samer Al Hadidi
- Department of Hematology and Oncology, Myeloma CenterWinthrop P. Rockefeller Cancer InstituteUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
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26
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Abdallah AO, Mahmoudjafari Z, Atieh T, Ahmed N, Cui W, Shune L, Mohan M, McGuirk J, Remker C, Foss M, Karloff E, Fitch H, Atrash S. Neutralizing antibody responses against SARS-CoV-2 in patients with plasma cell disorders who are on active treatment after two doses of mRNA vaccination. Eur J Haematol 2022; 109:458-464. [PMID: 35810359 PMCID: PMC9350358 DOI: 10.1111/ejh.13826] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
Many patients with plasma cell disorder (PCD) on active treatment with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) require hospitalization, with an increased mortality rate over healthy adults. The FDA approved two mRNA vaccines against SARS-CoV-2: BNT162b2 & mRNA-1273. To assess the efficacy of vaccination in patients with PCD, retrospectively, we identified all patients on active treatment. A total of 149 patients were included. Neutralizing antibodies (NAbs) levels against SARS-CoV-2 adequate, intermediate and no response were observed in 42%,32% and 26%, respectively. Low NAbs were seen in patients on daratumumab combinations or anti-BCMA therapy, low lymphocytes, and low IgG levels. Twenty-three (15%) patients have SARS CoV-2, while 8% required hospitalization, majority of these patients had intermediate or no response based on NAbs levels.Therefore, checking NAbs may be clinically helpful in identifying patients' responses. Further prospective studies should ascertain the value of a 3rd vaccine dose in this population.
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Affiliation(s)
- Al-Ola Abdallah
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA.,US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, USA
| | - Zahra Mahmoudjafari
- University of Kansas Medical Center, Westwood, KS, USA.,US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, USA
| | - Tahani Atieh
- University of Kansas Medical Center, Westwood, KS, USA
| | - Nausheen Ahmed
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA.,US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, USA
| | - Wei Cui
- University of Kansas Medical Center, Westwood, KS, USA.,US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, USA
| | - Leyla Shune
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA.,US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, USA
| | - Meera Mohan
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.,US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, USA
| | - Joseph McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA
| | - Cassie Remker
- University of Kansas Medical Center, Westwood, KS, USA
| | - Margaret Foss
- University of Kansas Medical Center, Westwood, KS, USA
| | - Ellie Karloff
- University of Kansas Medical Center, Westwood, KS, USA
| | - Heather Fitch
- University of Kansas Medical Center, Westwood, KS, USA
| | - Shebli Atrash
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA.,US Myeloma Research Innovations Research Collaborative (USMIRC), Westwood, KS, USA
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27
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Mohan M, Becnel MR, Shah UA, Dong H, Gundarlapalli S, Peterson T, Orozco JS, Horowitz S, Chhabra S, Dhakal B, Thanendrarajan S, Radhakrishnan SV, Hadidi SA, Tan C, Mailankody S, Hultcrantz M, Korde N, Hassoun H, Lesokhin AM, Thomas SK, Patel KK, Manasanch EE, Weber DM, Szabo A, Kaufman GP, Lee HC, Zangari M, van Rhee F, Usmani SZ, D’Souza A, Orlowski RZ, Schinke C. Clinical efficacy of sequencing CD38 targeting monoclonal antibodies in relapsed refractory multiple myeloma: A multi-institutional experience. Am J Hematol 2022; 97:E276-E280. [PMID: 35472167 PMCID: PMC10476149 DOI: 10.1002/ajh.26580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/26/2022] [Accepted: 04/18/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Meera Mohan
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Melody Renee Becnel
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Urvi A. Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Huaying Dong
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Sravani Gundarlapalli
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | | | - Sandra Horowitz
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Saurabh Chhabra
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Binod Dhakal
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Sharmilan Thanendrarajan
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Samer Al Hadidi
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander M. Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sheeba K. Thomas
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Krina K. Patel
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Elisabet E. Manasanch
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Donna M. Weber
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Aniko Szabo
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Gregory P. Kaufman
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Hans C. Lee
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Maurizio Zangari
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Frits van Rhee
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Saad Z. Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anita D’Souza
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Robert Z. Orlowski
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Carolina Schinke
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Hammons L, Szabo A, Dhakal B, Venniyil Radhakrishnan S, Chhabra S, D'Souza A, Mohan M. Kinetics of humoral immunodeficiency with bispecific antibody therapy in multiple myeloma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8049] [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
8049 Background: Bispecific antibodies (bsAb) are a promising class of therapeutics in RRMM. While hypogammaglobinemia (HGG) is anticipated due to plasma cell depletion, there is a lack of information about the degree of secondary immunodeficiency and resultant infectious complications. We investigated the kinetics of HGG in patients with RRMM on bsAb therapy. Methods: We identified and followed 42 patients treated on early clinical trials of bsAb at our institution between 2019 and 2021. Serial immunoglobulin levels and infections were obtained from the start of therapy until last follow up or 3 months after study exit. Results: 49 treatment courses were included from 42 individual patients. All patients were triple class exposed with a median of 5 prior lines of therapy. The median age was 67 (44-85) years, with 49% females. African Americans accounted for 18% of patients. 96% of patients had at least one prior ASCT. 90% of patients received bsAb targeting BCMA including 7 patients who received more than one line of BCMA targeting therapies. At a median follow up 9.5 (0.9-28.6) months, 40.8% of patients remained on bsAb therapy. At the start of therapy, the median IgG, IgA, and IgM levels were 560 (44-9436), 15 (5-3886) and 6 (5-64) mg/dL, respectively and 50% of patients had severe HGG (≤400mg/dl). Serum IgG levels reached a nadir at 3 months while, IgA and IgM at 1 month, from the start of therapy. The median nadir levels of IgG were 159 (40-2996) mg/dL, while it was < 5 mg/dL for both IgA and IgM. IgG levels were below the detectable range ( < 40 mg/dl) in 28% of patients at some point during therapy. IgA and IgM were also below the detectable range ( < 5 mg/dl) in 50% and 60% of patients, respectively. At last follow-up, the median IgG levels were 444 (40-1860) mg/dL and IgA 5 (5-254) mg/dL and IgM 5 (5-44) mg/dL. Additionally, 38% of patients remained severely hypogammaglobinemic. 57% (24/42) of patients received IVIG supplements in the current series. About 71% of patients had at least one infectious event and the cumulative incidence of infections progressively increased with increasing duration of therapy with risk at 3, 6, 9 12, 15 months being 41%, 57%, 64%, 67% and 70%, respectively. Among these, 54% of infection were bacterial. Viral infection accounted for 41% of infections. A third of patients had new infectious events during the first 90 days following stopping bsAb treatment. 57% (8/14) of patients did not mount a response to the primary COVID19 immunization series. Among the five patients with repeat antibody titers after the booster dose, 50% were still not able to mount an antibody response. Conclusions: bsAb therapy in RRMM can be associated with profound and prolonged HGG. The cumulative risk of infection correlated with the degree of HGG and progressively increases with treatment and persisted months after being off therapy. Additionally, an impaired antibody response to the COVID-19 immunization series was also noted.
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Dweik A, Dweik H, Mian H, Mohan M, Schinke CD, Al Hadidi S. Gender disparities in multiple myeloma publications. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e23000] [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
e23000 Background: Gender disparities exist in academia and are disproportionately affecting females. We conducted a cross sectional study to analyze gender disparities in MM publications in high impact hematology/oncology journals between January 1st, 2016 and December 31st, 2020. Methods: Data was collected through Medline/PubMed database search. High impact journals (impact factor > 10) with at least ten MM related publications were included. Impact factor data was based on the 2016 InCites Journal Citation Report. We used Genderize, a validated database, to determine authors’ gender. Search engines were used if gender was undetermined or did not meet a cut-off of 0.9. Unclassified genders after search were excluded from analysis. Results: A total of 679 publications with 8898 authorships were analyzed. Mean number of authors for females vs. males, per publication was 4.4 and 8.7, respectively. Females constituted a third of total authors. Female first authors, corresponding authors and last/senior authors were 34%, 21% and 18%, respectively. 17% of authors of clinical trial publications were females. Publications by country had comparable percentages (30% females as first authors in the U.S. vs. 32% females as first authors in other countries). The proportion of female authorship in 2020 when compared to 2016 was similar (33%). Between 2016 and 2020, there was slight improvement in female first authors (32%-37%), last authors (16%-21%), and corresponding authors (17%-22%). Conclusions: Gender disparities in MM publications exist and are more obvious in the last/corresponding authorship in both the U.S. and other countries. Despite improvement in proportion of female authors, it remains suboptimal when compared to the growing proportion of female physicians. Efforts should be made to identify factors that contribute to these disparities and work to resolve them.
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Affiliation(s)
| | | | - Hira Mian
- McMaster University, Hamilton, ON, Canada
| | | | - Carolina D. Schinke
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Samer Al Hadidi
- University of Arkansas for Medical Sciences, Little Rock, AR
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Mohan M, Gundarlapalli S, Szabo A, Yarlagadda N, Kakadia S, Konda M, Jillella A, Fnu A, Ogunsesan Y, Yarlagadda L, Thalambedu N, Munawar H, Graziutti M, Al Hadidi S, Alapat D, Thanendrarajan S, Zangari M, van Rhee F, Schinke C. Tandem autologous stem cell transplantation in patients with persistent bone marrow minimal residual disease after first transplantation in multiple myeloma. Am J Hematol 2022; 97:E195-E198. [PMID: 35285981 DOI: 10.1002/ajh.26530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/24/2022] [Accepted: 03/06/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Meera Mohan
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Sravani Gundarlapalli
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Aniko Szabo
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Naveen Yarlagadda
- Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sunilkumar Kakadia
- Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Manojna Konda
- Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anusha Jillella
- Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amisha Fnu
- Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Yetunde Ogunsesan
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lakshmi Yarlagadda
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nishant Thalambedu
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hussain Munawar
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Monica Graziutti
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Samer Al Hadidi
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Daisy Alapat
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sharmilan Thanendrarajan
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Maurizio Zangari
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Frits van Rhee
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Carolina Schinke
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Sivakumar G, Mohan M, Subaharan K, Venkatesan T, Yelshetti S, Kannan M, Anandham R, Yandigeri MS, Kumari S, Elango K, Kumar PR. Gut bacteria mediated insecticide resistance in cotton leafhopper <i>Amrasca biguttula biguttula</i>. CURR SCI INDIA 2022. [DOI: 10.18520/cs/v122/i8/958-964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abid MB, Rubin M, Ledeboer N, Szabo A, Longo W, Mohan M, Shah NN, Fenske TS, Abedin S, Runaas L, D'Souza A, Chhabra S, Dhakal B, Hamadani M. Efficacy of a third SARS-CoV-2 mRNA vaccine dose among hematopoietic cell transplantation, CAR T cell, and BiTE recipients. Cancer Cell 2022; 40:340-342. [PMID: 35202585 PMCID: PMC8864440 DOI: 10.1016/j.ccell.2022.02.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Muhammad Bilal Abid
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Micah Rubin
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan Ledeboer
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Walter Longo
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nirav N Shah
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy S Fenske
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sameem Abedin
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lyndsey Runaas
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA.
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Dong J, Garacci Z, Buradagunta CS, D'Souza A, Mohan M, Cunningham A, Janz S, Dhakal B, Thrift AP, Hari P. Black patients with multiple myeloma have better survival than white patients when treated equally: a matched cohort study. Blood Cancer J 2022; 12:34. [PMID: 35210395 PMCID: PMC8873507 DOI: 10.1038/s41408-022-00633-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 11/12/2021] [Revised: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 01/07/2023] Open
Abstract
We assessed differences in survival between non-Hispanic black (NHB) and non-Hispanic white (NHW) patients with multiple myeloma (MM), and the sequential effects of patient characteristics, and diagnosis and treatment-related factors on the survival disparity using data from 3319 NHB and 20,831 NHW MM patients in the SEER-Medicare (1999-2017) database. Four sets of 3319 NHWs were matched sequentially to the same set of 3319 NHBs, based on demographics (age, sex, year of diagnosis, marital status, and SEER site), socioeconomic status (SES, demographics plus SES), presentation factors (SES variables plus comorbidity), and treatment factors (presentation variables plus antimyeloma therapies). We found NHBs were less likely to receive treatment than NHWs even among patients matched for demographics, SES, and comorbidities. The absolute difference in 5-year survival between NHBs and NHWs was not significant in the demographics match (0.6%; P = 0.30) and remained non-significant after matching for SES (1.4%, P = 0.17). When matching for presentation, NHBs had significantly longer 5-year survival than NHWs (absolute difference = 3.8%, P = 0.003). Additional matching on treatment-related factors further enlarged the racial difference in 5-year survival to 4.6% (P < 0.001). Our findings reinforce the importance of equitable access to effective treatment modalities to further improve the survival of NHB patients with MM.
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Affiliation(s)
- Jing Dong
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
| | - Zhuping Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Anita D'Souza
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Meera Mohan
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ashley Cunningham
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Siegfried Janz
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Binod Dhakal
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, and Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Parameswaran Hari
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
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Foo J, Yen C, Khaw J, Ho H, Chong W, Toh T, Mohan M, Liew H. Clinical outcome of COVID-19 patients with cardiac disease in Queen Elizabeth Hospital Sabah. Int J Cardiol 2021. [PMCID: PMC8719230 DOI: 10.1016/j.ijcard.2021.10.104] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abdallah A, Mohyuddin GR, Ahmed N, Mohan M, Cui W, Shune L, Mahmoudjafari Z, McGuirk J, Ganguly S, Atrash S. Outcomes of VDPACE with an immunomodulatory agent as a salvage therapy in relapsed/refractory multiple myeloma with extramedullary disease. EJHaem 2021; 2:757-764. [PMID: 35845187 PMCID: PMC9175829 DOI: 10.1002/jha2.275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 04/21/2023]
Abstract
Extramedullary disease (EMD) is an aggressive form of multiple myeloma (MM). Confirming the presence of plasma cells outside the bone marrow makes the diagnosis of EMD. There is no clear consensus on the management of EMD in MM, and this entity continues to remain an unmet need. Rapidly controlling EMD to prevent end-organ damage is a priority. Retrospectively, we reviewed our database for patients with EMD that received treatment with bortezomib, dexamethasone, cisplatin, doxorubicin, cyclophosphamide, etoposide (VDPACE) plus an immune modulator (IMiD) regimen. We identified 21 patients with a median age of 61 years. Ten patients received a VDPACE based regimen as a bridge to autologus stem cell transplant (ASCT). After a median follow-up of 51.4 months, the median overall survival (OS) and progression-free survival were 14.9 months (95% CI: 7.8-NA) and 5.5 months (95% CI: 3.9-NA), respectively. The overall response rate was 76%, with a manageable safety profile. Interestingly, these results were similar regardless of the presence of high-risk cytogenetics. The safety profile was acceptable. In conclusion, a salvage VDPACE-based regimen plus an IMiD remains an effective and safe bridging therapy to future ASCT and immunotherapy in relapsed/refractory multiple myeloma patients with EMD.
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Affiliation(s)
- Al‐Ola Abdallah
- Division of Hematologic Malignancies & Cellular TherapeuticsUniversity of Kansas Medical CenterWestwoodKansasUSA
| | | | - Nausheen Ahmed
- Division of Hematologic Malignancies & Cellular TherapeuticsUniversity of Kansas Medical CenterWestwoodKansasUSA
| | - Meera Mohan
- Division of Hematology/OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Wei Cui
- Division of Pathology & Laboratory MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Leyla Shune
- Division of Hematologic Malignancies & Cellular TherapeuticsUniversity of Kansas Medical CenterWestwoodKansasUSA
| | | | - Joseph McGuirk
- Division of Hematologic Malignancies & Cellular TherapeuticsUniversity of Kansas Medical CenterWestwoodKansasUSA
| | - Siddhartha Ganguly
- Division of Hematologic Malignancies & Cellular TherapeuticsUniversity of Kansas Medical CenterWestwoodKansasUSA
| | - Shebli Atrash
- Levine Cancer InstituteCarolinas Healthcare SystemCharlotteNorth CarolinaUSA
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Tan L, Mullins W, Gargan K, Shea J, Brice J, Gargan A, Townsend J, Jang C, Shukla S, Asif A, Fricker M, Nathan A, Mohan M. 734 Evaluation of A Webinar Based Surgical Teaching Course (EDUCATE) - A Prospective Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.008] [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: 11/14/2022]
Abstract
Abstract
Aim
Anecdotal evidence suggests Foundation Year (FY) doctors start surgical rotations with less confidence than medical rotations. The study aimed to determine the effect of a national webinar-based surgical teaching course on participants’ confidence, and to assess attitudes surrounding undergraduate surgical education.
Method
This prospective cohort study is reported with reference to STROBE guidelines and received ethical approval. A series of 15 free-access webinars was developed based on the Royal College of Surgeons Undergraduate Curriculum. An expert-validated questionnaire was used to collect data before and after the course. Inclusion criteria were UK-based medical students and FY doctors who attended at least one webinar. The primary outcome was confidence in completing common tasks during surgical rotations.
Results
Completed pre-course (484) and post-course (352) questionnaires yielded 92 paired samples (63% female). 85% were medical students, representing 29 UK universities, and 15% FY doctors. Mean confidence in assessing, investigating, and implementing initial management of surgical conditions was greater after the intervention (p ≤ 0.001). Mean confidence in managing on-call tasks and starting a surgical FY job was also higher post-course greater (p ≤ 0.001). These improvements correlated with webinar attendance (p ≤ 0.05). 27.1% of participants were satisfied with the quality of undergraduate surgical education. 22.9% agreed that surgical placements prepared them well to manage surgical tasks.
Conclusions
Medical students and FY doctors report low confidence and feel unprepared in managing surgical tasks. Additionally, they report poor satisfaction with undergraduate surgical education. This shortfall may be improved through delivery of a national, accessible, targeted online webinar series and curriculum.
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Affiliation(s)
- L Tan
- University of Cambridge, Cambridge, United Kingdom
| | - W Mullins
- University of Cambridge, Cambridge, United Kingdom
| | - K Gargan
- University of Cambridge, Cambridge, United Kingdom
| | - J Shea
- University of Cambridge, Cambridge, United Kingdom
| | - J Brice
- University of Cambridge, Cambridge, United Kingdom
| | - A Gargan
- Charing Cross Hospital, London, United Kingdom
| | - J Townsend
- Harrogate Hospital, Harrogate, United Kingdom
| | - C Jang
- University of Cambridge, Cambridge, United Kingdom
| | - S Shukla
- University of Cambridge, Cambridge, United Kingdom
| | - A Asif
- University of Leicester, Leicester, United Kingdom
| | - M Fricker
- University of Newcastle, Newcastle, United Kingdom
| | - A Nathan
- Royal Free Hospital, London, United Kingdom
| | - M Mohan
- Addenbrookes Hospital, Cambridge, United Kingdom
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Yarlagadda N, Gundarlapalli S, Sharma S, Suelzer E, Abid MB, Abdallah AO, Schinke C, Atrash S, Mohan M. Hematological and infectious complications with CD38 antigen targeting monoclonal antibody-based therapies in multiple myeloma: A meta-analysis of randomized control trials. Leuk Res 2021; 110:106714. [PMID: 34598075 DOI: 10.1016/j.leukres.2021.106714] [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: 07/29/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Naveen Yarlagadda
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | | | - Smriti Sharma
- Unversity of Nebraska Medical Center, Omaha, NE, United States
| | | | | | | | - Carolina Schinke
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Shebli Atrash
- Atrium Health Levine Cancer Institute, NC, United States
| | - Meera Mohan
- Medical College of Wisconsin, Milwaukee, WI, United States.
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Mohan M, Maatman TC, Schinke C. The Role of Monoclonal Antibodies in the Era of Bi-Specifics Antibodies and CAR T Cell Therapy in Multiple Myeloma. Cancers (Basel) 2021; 13:4909. [PMID: 34638393 PMCID: PMC8507719 DOI: 10.3390/cancers13194909] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 01/01/2023] Open
Abstract
Multiple myeloma (MM) remains largely incurable despite enormous improvement in the outcome of patients. Over the past decade, we have witnessed the "era of monoclonal antibody (moAb)", setting new benchmarks in clinical outcomes for relapsed and newly diagnosed MM. Due to their excellent efficacy and relative safe toxicity profile, moAbs in combination with immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs) have become the new backbone of upfront anti-MM therapy. Yet, most patients will eventually relapse and patients who become refractory to IMiDs, PIs and moAbs have a dismal outcome. Emerging T-cell directing therapies, such as bispecific antibody (bsAb) and chimeric antigen receptor T cells (CAR T) have shown unprecedented responses and outcomes in these heavily pretreated and treatment-refractory patients. Their clinical efficacy combined with high tolerability will likely lead to the use of these agents earlier in the treatment course and there is great enthusiasm that a combination of T cell directed therapy with moAbs can lead to long duration remission in the near future, possibly even without the need of high dose chemotherapy and stem cell transplantation. Herein, we summarize the role of naked moAbs in MM in the context of newer immunotherapeutic agents like bsAb and CAR T therapy.
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Affiliation(s)
- Meera Mohan
- Divicion of Hematology/Oncology, Froedtert Clinical Cancer Center, Medical College of Wisconsin Cancer Center, Milwaukee, WI 53226, USA;
| | - Theresa Camille Maatman
- Divicion of Hematology/Oncology, Froedtert Clinical Cancer Center, Medical College of Wisconsin Cancer Center, Milwaukee, WI 53226, USA;
| | - Carolina Schinke
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Mohan M, Szabo A, Yarlagadda N, Gundarlapalli S, Thanendrarajan S, Kendrick S, Schinke C, Alapat D, Sawyer J, Tian E, Tricot G, Rhee F, Zangari M. Persistent bone marrow minimal residual disease as a "high-risk" disease feature in multiple myeloma. Am J Hematol 2021; 96:E341-E344. [PMID: 34050985 DOI: 10.1002/ajh.26255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Meera Mohan
- Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Aniko Szabo
- Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Naveen Yarlagadda
- Division of Hematology Oncology University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | | | | | - Samantha Kendrick
- Department of Biochemistry and Molecular Biology University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Carolina Schinke
- Myeloma Center University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Daisy Alapat
- Department of Pathology University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Jeffrey Sawyer
- Myeloma Center University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Erming Tian
- Myeloma Center University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Guido Tricot
- Myeloma Center University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Frits Rhee
- Myeloma Center University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Maurizio Zangari
- Myeloma Center University of Arkansas for Medical Sciences Little Rock Arkansas USA
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Kannan M, Geetha N, Elango K, Mohan M, Sivakumar G. Characterization of granulosis viruses of sugarcane early shoot borer, Chilo infuscatellus (Snell.) and internode borer, Chilo sacchariphagus indicus (Kapur). CURR SCI INDIA 2021. [DOI: 10.18520/cs/v121/i4/570-573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pennipede D, Mohyuddin GR, Hawkins R, Ganguly S, Shune L, Ahmed N, Mohan M, Cui W, Mahmoudjafari Z, McGuirk J, Atrash S, Abdallah AO. Carfilzomib, cyclophosphamide, and dexamethasone (KCd) for the treatment of triple-class relapsed/refractory multiple myeloma (RRMM). Eur J Haematol 2021; 107:602-608. [PMID: 34378251 DOI: 10.1111/ejh.13697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/29/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Multiple myeloma (MM) is an incurable hematologic malignancy, and outcomes remain poor for patients with triple-class relapsed/refractory MM (RRMM). Descriptive analyses were performed on available data for patient characteristics, disease course, and outcomes of the KCd on triple-class RRMM patients at our institution. PATIENTS AND METHODS Twenty-three patients with triple-class RRMM treated with KCd between June 2017 and October 2020 were included in our analysis. The regimen KCd consisted of 28 days cycles of carfilzomib 20/36 mg/m2 IV on days 1, 2, 8, 9, 15, and 16, cyclophosphamide 300 mg/m2 IV weekly, and dexamethasone (20-40) mg orally weekly. RESULTS Patients received a median of 6 (3-10) prior regimens. The median number of cycles administered was 4 (1-11) cycles. Overall response rate was 52%, 6 patients (26%) achieved very good partial response (VGPR), 6 patients (26%) achieved partial response (PR), and 5 patients (22%) achieved stable disease (SD). Progression-free survival (PFS) and Overall-survival (OS) were 4 and 11.9 months, respectively. There was no reported treatment-related mortality. The most common grade ≥3 adverse events were neutropenia (26%), thrombocytopenia (56.5%), and anemia (56.5%). CONCLUSIONS KCd showed clinically meaningful efficacy and manageable safety profile in patients with triple-class RRMM in real-world.
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Affiliation(s)
| | - Ghulam Rehman Mohyuddin
- University of Kansas Medical Center, Westwood, Kansas, USA.,US Myeloma Research Consortium (USMRC), Westwood, Kansas, USA
| | - Ryan Hawkins
- University of Kansas Medical Center, Westwood, Kansas, USA
| | - Siddhartha Ganguly
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Leyla Shune
- US Myeloma Research Consortium (USMRC), Westwood, Kansas, USA.,Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Nausheen Ahmed
- US Myeloma Research Consortium (USMRC), Westwood, Kansas, USA.,Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Meera Mohan
- US Myeloma Research Consortium (USMRC), Westwood, Kansas, USA.,Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wei Cui
- US Myeloma Research Consortium (USMRC), Westwood, Kansas, USA.,Division of Pathology & Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Zahra Mahmoudjafari
- University of Kansas Medical Center, Westwood, Kansas, USA.,US Myeloma Research Consortium (USMRC), Westwood, Kansas, USA
| | - Joseph McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Shebli Atrash
- US Myeloma Research Consortium (USMRC), Westwood, Kansas, USA.,Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - Al-Ola Abdallah
- US Myeloma Research Consortium (USMRC), Westwood, Kansas, USA.,Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
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Mohan M, Meek JC, Meek ME, Broadwater R, Alapat D, van Rhee F. Combinatorial treatment for unresectable unicentric Castleman disease. Eur J Haematol 2021; 107:484-488. [PMID: 34242421 DOI: 10.1111/ejh.13685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 01/20/2023]
Abstract
Unresectable, symptomatic unicentric Castleman disease (UCD) can represent a formidable therapeutic challenge. UCD masses are often highly vascularized offering the opportunity for therapeutic embolization. Herein, we report on 6 patients in which therapeutic embolization was combined with other medical interventions including surgery (n = 3), rituximab (n = 6), cryoablation (n = 2), and chemotherapy (n = 3). Five patients had significant tumor volume reductions (median: 83.2%; range: 76.7-100). All five responding patients had resolution of symptomatology. There were no serious complications in the patients who received embolization and proceeded to surgery. In conclusion, effective disease and symptom control can be obtained in patients with symptomatic, unresectable UCD by combining different therapeutic interventions.
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Affiliation(s)
- Meera Mohan
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James C Meek
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mary Elizabeth Meek
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ralph Broadwater
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Daisy Alapat
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Frits van Rhee
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Mohan M, Hari P, Szabo A, Dhakal B, Chhabra S, D'Souza A. Long term follow up of newly diagnosed multiple myeloma patients treated with pembrolizumab consolidation post-autologous stem cell transplantation. Leuk Res 2021; 109:106648. [PMID: 34182226 DOI: 10.1016/j.leukres.2021.106648] [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: 05/17/2021] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Meera Mohan
- Medical College of Wisconsin, United States.
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Yarlagadda L, Gundarlapalli S, Parikh R, Kottarathara M, Ogunsesan Y, Hoque S, Mitma A, Bailey C, Hill K, Thanendrarajan S, Grazziutti M, Mohan M, Zangari M, Van Rhee F, Tricot G, Schinke CD. Salvage autologous stem cell transplantation in daratumumab refractory multiple myeloma (MM). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e20031] [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
e20031 Background: The advent of novel therapies has significantly improved outcomes in MM, yet most patients will eventually relapse. Patients progressing on CD38-targeting monoclonal antibodies, proteasome inhibitors (PIs) and IMiDs have dismal outcome. While treatment modalities based on novel mechanisms have shown promising results, the current study explores the use of high dose chemotherapy followed by autologous stem cell transplantation (ASCT) in these heavily pretreated MM patients. Methods: We investigated the outcome of 57 patients who received salvage ASCT after MM progression on Daratumumab. All patients had also been exposed to at least two PIs and two IMiDs. We assessed overall response using IMWG criteria, minimal residual disease (MRD) using 8 color flow cytometry with a sensitivity of 10-5, progression free (PFS) and overall survival (OS). Results: Median age of the patient cohort was 62 years (39-75) and all patients had been exposed to Daratumumab, Thalidomide, Revlimid and Velcade. 93% (53/57), 91% (52/57) and 32% (18/57) of the patients had also received Carfilzomib, Pomalidomide and Ixazomib respectively. Pre-ASCT conditioning regimen included high dose melphalan in 23% (13/57), melphalan in combination with VDT-PACE (Velcade, Dexamethasone, Thalidomide, Cisplatin, Adriamycin, Cytoxan and Etoposide) in 30% (17/57) and BEAM (BCNU, Etoposide, Ara-C and Melphalan) in 47% (27/57). Post-ASCT response was assessed in 90% (51/57) within 100 days of ASCT. Overall response rate was 81% (46/57) with a CR in 39% (22/57), a VGPR in 23% (13/57) and a PR in 19% (11/57). Stable disease was seen in 3.5% (2/57) and progressive disease in 5% (3/53) patients. MRD negativity was attained in 44% (25/57) patients, all of whom had at least a VGPR. After response assessment, patients were started on maintenance treatment with combinations of either previously used agents (pomalidomide [20/57], carfilzomib [11/57] and CD38 moAbs [16/57]) or agents with no or little prior exposure (cytoxan [11/57], selinexor [4/57] or venetoclax [3/57]). The median PFS for the entire patient cohort was 8.5 months with a median OS of 19.6 months. For patients with ≥ VGPR, median PFS and OS improved to 11 months and 24.9 months respectively. Achievement of MRD negativity in ≥ VGPR did not improve outcome, median PFS = 11 and median OS = 20 months. 17% (10/57) of patients were still alive at 36months post salvage ASCT. Conclusions: High dose chemotherapy followed by ASCT achieves substantial responses in 81% of patients with 17.5 % still alive at 3 years. The results suggest a role for salvage ASCT in selected heavily pre-treated patients, albeit there remains an obvious clinical need for novel therapies. While the achievement of ≥ VGPR improved outcome, achievement of MRD negativity had no further impact on survival in our study, although that may be due to the relative small number of patients and the major overlap between ≥VGPR and MRD negativity.
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Affiliation(s)
- Lakshmi Yarlagadda
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Richa Parikh
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mathew Kottarathara
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Yetunde Ogunsesan
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Shadiqul Hoque
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Angel Mitma
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Clyde Bailey
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Kerri Hill
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Monica Grazziutti
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Maurizio Zangari
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Frits Van Rhee
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Guido Tricot
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Carolina D. Schinke
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
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Abstract
Multiple myeloma (MM) is a genetically heterogenous disease and remains mostly incurable with a small group of patients achieving long-term disease remission. The past decade witnessed enormous efforts to break the circulus vitiosus of tumor-induced immunosuppression and to re-engage the immune system to fight cancer. The first-in-class anti-CD38 monoclonal antibody, daratumumab, has shown unprecedented responses especially in combination with other novel agents in both newly diagnosed and relapsed MM. There has been great interest in harnessing the power of T cells with bispecific antibodies and chimeric antigen receptor T-cell therapies in hematologic malignancies including MM. These immune-based approaches have shown notable antimyeloma effects with deeper, durable responses in early clinical trials of heavily pretreated patients with MM with limited therapeutic options. Several trials are underway investigating both single and combinatorial immune therapies at different stages with a hope to bring major transformation in MM. In the current review, we summarize how an immunologic approach offers promise for the treatment of MM and is setting the stage for second major paradigm shift 2 decades after the emergence of thalidomide and novel therapeutics.
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Affiliation(s)
- Meera Mohan
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Parameswaran Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Binod Dhakal
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
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Bhandoria G, Gadgil A, Khajanchi M, Sarang B, Kizhakke Veetil D, Wadhawan R, Bhandarkar P, Mohan M, Shah P, Bains L, Mishra A, Arora S, Rattan A, Kant R, Sharma N, Bhavishi D, Satoskar RR, Prajapati R, Srivastava KS, Kamble P, Mayadeo NM, Gokhale A, Jaydeep H, Belekar D, Roy N. Effects of the COVID-19 pandemic on delivery of emergency surgical care in India. Br J Surg 2021; 108:e154-e155. [PMID: 33793717 PMCID: PMC7929169 DOI: 10.1093/bjs/znab004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022]
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Tan L, Mullins W, Gargan A, Townsend J, Gargan K, Brice J, Shea J, Jang C, Shukla S, Asif A, Fricker M, Mohan M, Nathan A. 429 National Evaluation of Confidence and Preparedness for Surgical Rotations in Medical Students and Foundation Year Doctors. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.140] [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: 11/13/2022]
Abstract
Abstract
Introduction
Limited published and anecdotal evidence suggests foundation year (FY) doctors start their surgical rotations with lower confidence than medical rotations. This may be due to insufficient undergraduate practical teaching related to common surgical rotations. This study aimed to evaluate the confidence and preparedness for surgical rotations of medical students and FY doctors.
Method
An expert-validated questionnaire was distributed nationally to UK medical students and FY doctors. The primary outcome was confidence in completing common tasks during surgical rotations.
Results
491 participants (84% medical students, 16% FYs) were recruited from 36 UK medical schools. 80% were likely to pursue a career in surgery however only 7% felt confident about starting a surgical FY job. 66% felt neutral or unsatisfied about the quality of medical school surgical teaching, and 80% indicated that placements did not prepare them well to manage common FY surgical tasks. The internal reliability of the questionnaire was high (=0.939).
Conclusions
Medical students and FY doctors lack confidence and preparation for surgical jobs. High-quality, practically grounded educational courses such as the National Surgical Teaching Society (NSTS) webinar curriculum could improve confidence and preparedness for surgical rotations. Further research evaluating the benefits of such courses is warranted.
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Affiliation(s)
- L Tan
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - W Mullins
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - A Gargan
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - J Townsend
- Harrogate and District NHS Foundation Trust, Leeds, United Kingdom
| | - K Gargan
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - J Brice
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - J Shea
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - C Jang
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - S Shukla
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - A Asif
- Leicester University, Leicester, United Kingdom
| | - M Fricker
- Newcastle University, Newcastle, United Kingdom
| | - M Mohan
- University of Cambridge, Department of Clinical Neurosciences, Cambridge, United Kingdom
| | - A Nathan
- Royal Free London, NHS Foundation Trust, London, United Kingdom
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Mohan M, Kumar M, Samant R, Van Hemert R, Tian E, Desai S, van Rhee F, Thanendrarajan S, Schinke C, Suva LJ, Sharma S, Milad M, Kendrick S, Zangari M. Bone remineralization of lytic lesions in multiple myeloma - The Arkansas experience. Bone 2021; 146:115876. [PMID: 33556629 PMCID: PMC8627246 DOI: 10.1016/j.bone.2021.115876] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/11/2022]
Abstract
Multiple myeloma (MM) patients frequently present with extensive osteolytic bone lesions. However, the impact of myeloma treatment on focal lytic lesion remineralization has not been extensively studied. In this study, the effect of anti-myeloma treatment on the extent of bone remineralization was examined and potential mediators identified. Newly diagnosed MM patients enrolled in the Total Therapy 4 and 5 (TT4; n = 231, TT5; n = 64) protocols were longitudinally evaluated for changes in radiological parameters for a median of 6.1 years. Bone remineralization was defined as a sclerotic CT change within the lytic lesion and quantified as a percentage of remineralization, using the initial lesion size as a reference. Such changes were correlated to clinical and biochemical parameters, and the gene expression profile of bone marrow biopsy. Overall, remineralization occurred in 72% of patients (213/295). Of those patients that experienced remineralization, 36% (107/295) achieved at least 25% of bone remineralization. Patients with high-risk disease defined by gene expression profile signature (GEP70 ≥ 0.66) experienced significant remineralization compared to low-risk MM. Female patients were also more likely to experience bone remineralization and in a shorter median time (2.0 vs. 3.3 y). Factors such as serum alkaline phosphatase along with high levels of RUNX2 and SOX4 gene expression correlated with increasing extent of bone remineralization. This analysis demonstrated significant remineralization of lytic lesions in MM patients treated on TT clinical trials. While the underlying mechanism remains elusive these findings support the hypothesis that patient baseline bone-related factors play a fundamental role in the skeletal repair of bone lesions in MM that provide new opportunities for improving patient outcomes.
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Affiliation(s)
- Meera Mohan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Manoj Kumar
- Department of Radiodiagnosis, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Rohan Samant
- Department of Radiodiagnosis, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Rudy Van Hemert
- Department of Radiodiagnosis, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Erming Tian
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Shivang Desai
- Department of Radiodiagnosis, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Frits van Rhee
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Sharmilan Thanendrarajan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Carolina Schinke
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Larry J Suva
- Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, TX, United States of America
| | - Shobhit Sharma
- Department of Radiodiagnosis, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Mohamed Milad
- Department of Bioinformatics, Arkansas State University, Jonesboro, AR, United States of America
| | - Samantha Kendrick
- Department of Biochemisty and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Maurizio Zangari
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
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Sarangi A, Das BS, Patnaik G, Sarkar S, Debnath M, Mohan M, Bhattacharya D. Potent anti-mycobacterial and immunomodulatory activity of some bioactive molecules of Indian ethnomedicinal plants that have the potential to enter in TB management. J Appl Microbiol 2021; 131:1578-1599. [PMID: 33772980 DOI: 10.1111/jam.15088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Abstract
Tuberculosis (TB) is one of the deadliest infectious diseases of human civilization. Approximately one-third of global population is latently infected with the TB pathogen Mycobacterium tuberculosis (M.tb). The discovery of anti-TB antibiotics leads to decline in death rate of TB. However, the evolution of antibiotic-resistant M.tb-strain and the resurgence of different immune-compromised diseases re-escalated the death rate of TB. WHO has already cautioned about the chances of pandemic situation in TB endemic countries until the discovery of new anti-tubercular drugs, that is, the need of the hour. Analysing the pathogenesis of TB, it was found that M.tb evades the host by altering the balance of immune response and affects either by killing the cells or by creating inflammation. In the pre-antibiotic era, traditional medicines were only therapeutic measures for different infectious diseases including tuberculosis. The ancient literatures of India or ample Indian traditional knowledge and ethnomedicinal practices are evidence for the treatment of TB using different indigenous plants. However, in the light of modern scientific approach, anti-TB effects of those plants and their bioactive molecules were not established thoroughly. In this review, focus has been given on five bioactive molecules of different traditionally used Indian ethnomedicinal plants for treatment of TB or TB-like symptom. These compounds are also validated with proper identification and their mode of action with modern scientific approaches. The effectiveness of these molecules for sensitive or drug-resistant TB pathogen in clinical or preclinical studies was also evaluated. Thus, our specific aim is to highlight such scientifically validated bioactive compounds having anti-mycobacterial and immunomodulatory activity for future use as medicine or adjunct-therapeutic molecule for TB management.
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Affiliation(s)
- A Sarangi
- Centre for Biotechnology, School of Pharmaceutical Sciences, SOA Deemed to be University, Bhubaneswar, Odisha, India
| | - B S Das
- Centre for Biotechnology, School of Pharmaceutical Sciences, SOA Deemed to be University, Bhubaneswar, Odisha, India
| | - G Patnaik
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, India
| | - S Sarkar
- Barsal High School, Rampurhat, West Bengal, India
| | - M Debnath
- Panskura Banamali College (Autonomous), Vidyasagar University, Panskura, West Bengal, India
| | - M Mohan
- ICMR-National Institute of Malarial Research (NIMR), New Delhi, India
| | - D Bhattacharya
- Centre for Biotechnology, School of Pharmaceutical Sciences, SOA Deemed to be University, Bhubaneswar, Odisha, India
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Mohan M, Yarlagadda N, Szabo A, Singh A, Pina Oviedo S, Schinke C. Clinical characteristics of testicular extramedullary involvement in multiple myeloma. Am J Hematol 2021; 96:E77-E81. [PMID: 33338289 DOI: 10.1002/ajh.26072] [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: 11/17/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Meera Mohan
- Division of Hematology‐Oncology Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Naveen Yarlagadda
- Division of Hematology Oncology University of Arkansas Little Rock Arkansas USA
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin
| | - Amrit Singh
- Department of Pathology, Hematopathology University of Arkansas Little Rock Arkansas USA
| | - Sergio Pina Oviedo
- Department of Pathology, Hematopathology University of Arkansas Little Rock Arkansas USA
| | - Carolina Schinke
- Division of Hematology Oncology University of Arkansas Little Rock Arkansas USA
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