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Hussaini SMQ, Ren Y, Racioppi A, Lew MV, Bohannon L, Johnson E, Li Y, Thompson JC, Henshall B, Darby M, Choi T, Lopez RD, Sarantopoulos S, Gasparetto C, Long GD, Horwitz ME, Chao NJ, Zafar SY, Sung AD. Financial Toxicity and Quality of Life in Patients Undergoing Stem-Cell Transplant Evaluation: A Single-Center Analysis. JCO Oncol Pract 2024; 20:351-360. [PMID: 38127876 DOI: 10.1200/op.23.00243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/27/2023] [Accepted: 10/23/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE We investigated the prevalence of financial toxicity in a population undergoing hematopoietic cell transplantation (HCT) evaluation and measured its impact on post-transplant clinical and health-related quality-of-life outcomes. MATERIALS AND METHODS This was a prospective study in patients undergoing evaluation for allogeneic HCT between January 1, 2018, and September 23, 2020, at a large academic medical center. Financial health was measured via a baseline survey and the comprehensive score for financial toxicity-functional assessment of chronic illness therapy (COST-FACIT) survey. The cohort was divided into three groups: none (grade 0), mild (grade 1), and moderate-high financial toxicity (grades 2-3). Health-related quality of life outcomes were measured at multiple time points. Multivariate logistic regression analysis evaluated factors associated with financial toxicity. Kaplan-Meier curves and log-rank tests was used to evaluate overall survival (OS) and nonrelapse survival. RESULTS Of 245 patients evaluated for transplant, 176 (71.8%) completed both questionnaires (median age was 57 years, 63.1% were male, 72.2% were White, and 39.2% had myelodysplastic syndrome, 38.1% leukemia, and 13.6% lymphoma). At initial evaluation, 83 (47.2%) patients reported no financial toxicity, 51 (29.0%) with mild, and 42 (23.9%) with moderate-high financial toxicity. Patients with financial toxicity reported significant cost-cutting behaviors, including reduced spending on food or clothing, using their savings, or not filling a prescription because of costs (P < .0001). Quality of life was lower in patients with moderate-high financial toxicity at 6 months (P = .0007) and 1 year (P = .0075) after transplant. Older age (>62; odds ratio [OR], 0.33 [95% CI, 0.13 to 0.79]; P = .04) and income ≥$60,000 in US dollars (USD) (OR, 0.17 [95% CI, 0.08 to 0.38]; P < .0001) were associated with lower odds of financial toxicity. No association was noted between financial toxicity and selection for transplant, OS, or nonrelapse mortality. CONCLUSION Financial toxicity was highly correlated with patient-reported changes in compensatory behavior, with notable impact on patient quality of life after transplant.
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Affiliation(s)
- S M Qasim Hussaini
- O'Neal Comprehensive Cancer, University of Alabama at Birmingham, Birmingham, AL
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Yi Ren
- Duke Cancer Institute Biostatistics Shared Resource, Durham, NC
| | | | - Meagan V Lew
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Lauren Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Ernaya Johnson
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Yan Li
- Duke Cancer Institute Biostatistics Shared Resource, Durham, NC
| | - Jillian C Thompson
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Bethany Henshall
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Maurisa Darby
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Richard D Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | | | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - S Yousuf Zafar
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
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Bracken SJ, Suthers AN, DiCioccio RA, Su H, Anand S, Poe JC, Jia W, Visentin J, Basher F, Jordan CZ, McManigle WC, Li Z, Hakim FT, Pavletic SZ, Bhuiya NS, Ho VT, Horwitz ME, Chao NJ, Sarantopoulos S. Heightened TLR7 signaling primes BCR-activated B cells in chronic graft-versus-host disease for effector functions. Blood Adv 2024; 8:667-680. [PMID: 38113462 PMCID: PMC10839617 DOI: 10.1182/bloodadvances.2023010362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
ABSTRACT Chronic graft-versus-host disease (cGVHD) is a debilitating, autoimmune-like syndrome that can occur after allogeneic hematopoietic stem cell transplantation. Constitutively activated B cells contribute to ongoing alloreactivity and autoreactivity in patients with cGVHD. Excessive tissue damage that occurs after transplantation exposes B cells to nucleic acids in the extracellular environment. Recognition of endogenous nucleic acids within B cells can promote pathogenic B-cell activation. Therefore, we hypothesized that cGVHD B cells aberrantly signal through RNA and DNA sensors such as Toll-like receptor 7 (TLR7) and TLR9. We found that B cells from patients and mice with cGVHD had higher expression of TLR7 than non-cGVHD B cells. Using ex vivo assays, we found that B cells from patients with cGVHD also demonstrated increased interleukin-6 production after TLR7 stimulation with R848. Low-dose B-cell receptor (BCR) stimulation augmented B-cell responses to TLR7 activation. TLR7 hyperresponsiveness in cGVHD B cells correlated with increased expression and activation of the downstream transcription factor interferon regulatory factor 5. Because RNA-containing immune complexes can activate B cells through TLR7, we used a protein microarray to identify RNA-containing antigen targets of potential pathological relevance in cGVHD. We found that many of the unique targets of active cGVHD immunoglobulin G (IgG) were nucleic acid-binding proteins. This unbiased assay identified the autoantigen and known cGVHD target Ro-52, and we found that RNA was required for IgG binding to Ro-52. Herein, we find that BCR-activated B cells have aberrant TLR7 signaling responses that promote potential effector responses in cGVHD.
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Affiliation(s)
- Sonali J. Bracken
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Amy N. Suthers
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Rachel A. DiCioccio
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Hsuan Su
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Sarah Anand
- Division of Hematology and Medical Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Jonathan C. Poe
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Wei Jia
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Jonathan Visentin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
- Department of Immunology and Immunogenetics, Bordeaux University Hospital, Bordeaux, France
- UMR CNRS 5164 ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Fahmin Basher
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Collin Z. Jordan
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham NC
| | - William C. McManigle
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham NC
| | - Zhiguo Li
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham NC
- Duke Cancer Institute, Duke University Medical Center, Durham NC
| | - Frances T. Hakim
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD
| | - Steven Z. Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD
| | - Nazmim S. Bhuiya
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD
| | - Vincent T. Ho
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Mitchell E. Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
- Duke Cancer Institute, Duke University Medical Center, Durham NC
| | - Nelson J. Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
- Duke Cancer Institute, Duke University Medical Center, Durham NC
- Department of Integrated Immunobiology, Duke University School of Medicine, Durham, NC
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
- Duke Cancer Institute, Duke University Medical Center, Durham NC
- Department of Integrated Immunobiology, Duke University School of Medicine, Durham, NC
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3
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Patel P, Dillon M, Niedzwiecki D, Crowell KA, Horwitz ME, Wang E, Kelsey CR. High risk of acute pulmonary toxicity with both myeloablative and non-myeloablative total body irradiation-based conditioning for allogeneic stem cell transplantation. Bone Marrow Transplant 2024; 59:150-152. [PMID: 37923832 DOI: 10.1038/s41409-023-02140-y] [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: 07/20/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Pranalee Patel
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mairead Dillon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, 27710, USA
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, 27710, USA
| | - Kerri-Anne Crowell
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mitchell E Horwitz
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, 27710, USA
| | - Edina Wang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, 27710, USA.
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4
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Rodríguez-Arbolí E, Lee CJ, Caballero-Velázquez T, Martínez C, García-Calderón C, Jiménez-León MR, Bermúdez-Rodríguez MA, López-Corral L, Triguero A, Onstad L, Horwitz ME, Sarantopoulos S, Lee SJ, Pérez-Simón JA. Targeting Hedgehog Signaling with Glasdegib in Patients with Refractory Sclerotic Chronic GVHD: A Report of Two Phase I/II Trials. Clin Cancer Res 2023; 29:4057-4067. [PMID: 37698881 DOI: 10.1158/1078-0432.ccr-23-0666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/08/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Sclerotic chronic GVHD (scGVHD) is characterized by progressive skin fibrosis and frequent refractoriness to available therapies. Aberrant activation of Hedgehog signaling in dermal fibroblasts has been implicated in scGVHD. Here, we report the results of two phase I/II studies (NCT03415867, GETH-TC; NCT04111497, FHD) that evaluated glasdegib, a smoothened antagonist, as a novel therapeutic agent in refractory scGVHD. PATIENTS AND METHODS Adult patients with active scGVHD after ≥1 (FHD) or ≥2 (GETH-TC) lines of therapy were enrolled. Primary endpoints were dose-limiting toxicity (DLT) and MTD in the GETH-TC trial, and safety and tolerability measures in the FHD trial. Glasdegib was administered once daily in 28-day cycles. Responses were scored per 2014 NIH cGVHD criteria. Correlative studies were performed to evaluate the role of fibroblast-independent immune mechanisms on clinical activity. RESULTS Twenty (GETH-TC) and 15 (FHD) patients were recruited. Treatment-emergent grade (G) ≥2 adverse events (AE) in the GETH-TC trial included muscle cramps (85%), alopecia (50%), and dysgeusia (35%). Two patients experienced a DLT (G3 muscle cramps), and the MTD was established at 50 mg. G3 muscle cramps were the most frequently reported AE (33%) in the FHD trial. At 12-months, the skin/joint scGVHD overall response rate was 65% (all partial responses) in the GETH-TC trial and 47% (6 partial responses, 1 complete response) in the FHD cohort. No immune correlates of response were identified. CONCLUSIONS Glasdegib demonstrated promising responses in patients with refractory scGVHD, but tolerability was limited by muscle cramping.
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Affiliation(s)
- Eduardo Rodríguez-Arbolí
- Department of Hematology, Hospital Universitario Virgen del Rocío, Seville Biomedicine Institute (IBiS/CSIC), University of Seville, Seville, Spain
| | - Catherine J Lee
- Utah Blood and Marrow Transplant Program, Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Teresa Caballero-Velázquez
- Department of Hematology, Hospital Universitario Virgen del Rocío, Seville Biomedicine Institute (IBiS/CSIC), University of Seville, Seville, Spain
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, IDIBAPS, Josep Carreras Research Institute, Hospital Clínic, Barcelona, Spain
| | - Clara García-Calderón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Seville Biomedicine Institute (IBiS/CSIC), University of Seville, Seville, Spain
| | - María Reyes Jiménez-León
- Department of Hematology, Hospital Universitario Virgen del Rocío, Seville Biomedicine Institute (IBiS/CSIC), University of Seville, Seville, Spain
| | | | - Lucía López-Corral
- Department of Hematology, Hospital Clínico Universitario de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Ana Triguero
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, IDIBAPS, Josep Carreras Research Institute, Hospital Clínic, Barcelona, Spain
| | - Lynn Onstad
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Duke Cancer Institute, Durham, NC
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Duke Cancer Institute, Durham, NC
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - José Antonio Pérez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Seville Biomedicine Institute (IBiS/CSIC), University of Seville, Seville, Spain
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5
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Horwitz ME. Blood stem cell grafts: frozen is fine, but fresh is best. Blood Adv 2023; 7:5994-5995. [PMID: 37815816 PMCID: PMC10580167 DOI: 10.1182/bloodadvances.2023010372] [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] [Indexed: 10/11/2023] Open
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6
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Lin C, Horwitz ME. Corrigendum to 'Multicenter Long-Term Follow-Up of Allogeneic Hematopoietic Cell Transplantation with Omidubicel: A Pooled Analysis of Five Prospective Clinical Trials'. Transplant Cell Ther 2023:S2666-6367(23)01356-8. [PMID: 37421972 DOI: 10.1016/j.jtct.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Affiliation(s)
- Chenyu Lin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
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7
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Poe JC, Fang J, Zhang D, Lee MR, DiCioccio RA, Su H, Qin X, Zhang JY, Visentin J, Bracken SJ, Ho VT, Wang KS, Rose JJ, Pavletic SZ, Hakim FT, Jia W, Suthers AN, Curry-Chisolm IM, Horwitz ME, Rizzieri DA, McManigle WC, Chao NJ, Cardones AR, Xie J, Owzar K, Sarantopoulos S. Single-cell landscape analysis unravels molecular programming of the human B cell compartment in chronic GVHD. JCI Insight 2023:169732. [PMID: 37129971 PMCID: PMC10393230 DOI: 10.1172/jci.insight.169732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Alloreactivity can drive autoimmune syndromes. After allogeneic hematopoietic stem cell transplantation (allo-HCT) chronic graft-versus-host disease (cGVHD), a B cell-mediated autoimmune-like syndrome, commonly occurs. Because donor-derived B cells continually develop under selective pressure from host alloantigens, aberrant B Cell Receptor (BCR)-activation and IgG production can emerge and contribute to cGVHD pathobiology. To better understand molecular programing of B cells under selective pressure of alloantigens, we performed scRNA-Seq analysis on high numbers of purified B cells from allo-HCT patients. An unsupervised analysis revealed 10 clusters, distinguishable by signature genes for maturation, activation and memory. We found striking transcriptional differences in the memory B cell compartment after allo-HCT compared to healthy or infected individuals. To identify intrinsic properties when B-cell tolerance is lost after allo-HCT, we then assessed clusters for differentially expressed genes (DEGs) between patients with vs. without autoimmune-like manifestations (Active cGVHD vs. No cGVHD, respectively). DEGs were found in Active cGVHD in both naive and BCR-activated clusters, suggesting functional diversity. Some DEGs were also differentially expressed across most clusters, suggesting common molecular programs that may promote B cell plasticity. Our study of human allo-HCT and cGVHD provides new understanding of B-cell memory in the face of chronic alloantigen stimulation.
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Affiliation(s)
- Jonathan C Poe
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Jiyuan Fang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Dadong Zhang
- Duke Cancer Institute, Duke University Medical Center, Durham, United States of America
| | - Marissa R Lee
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Rachel A DiCioccio
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Hsuan Su
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Xiaodi Qin
- Duke Cancer Institute, Duke University Medical Center, Durham, United States of America
| | - Jennifer Y Zhang
- Department of Dermatology, Duke University Medical Center, Durham, United States of America
| | - Jonathan Visentin
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Sonali J Bracken
- Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, United States of America
| | - Vincent T Ho
- Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Kathy S Wang
- Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Jeremy J Rose
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, United States of America
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, United States of America
| | - Frances T Hakim
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, United States of America
| | - Wei Jia
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Amy N Suthers
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Itaevia M Curry-Chisolm
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Mitchell E Horwitz
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - David A Rizzieri
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - William C McManigle
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Nelson J Chao
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Adela R Cardones
- Department of Dermatology, Duke University Medical Center, Durham, United States of America
| | - Jichun Xie
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Kouros Owzar
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Stefanie Sarantopoulos
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
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8
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Lin C, Schwarzbach A, Sanz J, Montesinos P, Stiff P, Parikh S, Brunstein C, Cutler C, Lindemans CA, Hanna R, Koh LP, Jagasia MH, Valcarcel D, Maziarz RT, Keating AK, Hwang WYK, Rezvani AR, Karras NA, Fernandes JF, Rocha V, Badell I, Ram R, Schiller GJ, Volodin L, Walters MC, Hamerschlak N, Cilloni D, Frankfurt O, McGuirk JP, Kurtzberg J, Sanz G, Simantov R, Horwitz ME. Multicenter Long-Term Follow-Up of Allogeneic Hematopoietic Cell Transplantation with Omidubicel: A Pooled Analysis of Five Prospective Clinical Trials. Transplant Cell Ther 2023; 29:338.e1-338.e6. [PMID: 36775201 PMCID: PMC10149622 DOI: 10.1016/j.jtct.2023.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
Omidubicel is an umbilical cord blood (UCB)-derived ex vivo-expanded cellular therapy product that has demonstrated faster engraftment and fewer infections compared with unmanipulated UCB in allogeneic hematopoietic cell transplantation. Although the early benefits of omidubicel have been established, long-term outcomes remain unknown. We report on a planned pooled analysis of 5 multicenter clinical trials including 105 patients with hematologic malignancies or sickle cell hemoglobinopathy who underwent omidubicel transplantation at 26 academic transplantation centers worldwide. With a median follow-up of 22 months (range, .3 to 122 months), the 3-year estimated overall survival and disease-free survival were 62.5% and 54.0%, respectively. With up to 10 years of follow-up, omidubicel showed durable trilineage hematopoiesis. Serial quantitative assessments of CD3+, CD4+, CD8+, CD19+, CD116+CD56+, and CD123+ immune subsets revealed median counts remaining within normal ranges through up to 8 years of follow-up. Secondary graft failure occurred in 5 patients (5%) in the first year, with no late cases reported. One case of donor-derived myeloid neoplasm was reported at 40 months post-transplantation. This was also observed in a control arm patient who received only unmanipulated UCB. Overall, omidubicel demonstrated stable trilineage hematopoiesis, immune competence, and graft durability in extended follow-up.
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Affiliation(s)
- Chenyu Lin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Jaime Sanz
- Hematology Department, Hospital Universitario y Polit
| | | | - Patrick Stiff
- Division of Hematology and Oncology, Loyola University Medical Center, Chicago, Illinois
| | | | - Claudio Brunstein
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota; Department of Hematology and Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | - Corey Cutler
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Caroline A Lindemans
- Department of Pediatric Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rabi Hanna
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic, Cleveland, Ohio
| | - Liang Piu Koh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Madan H Jagasia
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Valcarcel
- Department of Haematology and Haemotherapy, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Richard T Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Amy K Keating
- Blood and Marrow Transplantation, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - William Y K Hwang
- Department of Haematology, National Cancer Centre Singapore, Singapore; Department of Haematology, Singapore General Hospital, Singapore; Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore
| | - Andrew R Rezvani
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University School of Medicine, Stanford, California
| | - Nicole A Karras
- Department of Pediatrics, City of Hope National Medical Center, Duarte, California
| | | | | | - Isabel Badell
- Pediatric Haematology and Stem Cell Transplantation Unit, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Ron Ram
- BMT Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gary J Schiller
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Leonid Volodin
- Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | - Mark C Walters
- Benioff Children's Hospital, University of California San Francisco, Oakland, California
| | | | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Olga Frankfurt
- Division of Hematology and Oncology, Northwestern University, Chicago, Illinois
| | - Joseph P McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, Kansas
| | - Joanne Kurtzberg
- Division of Hematology-Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Guillermo Sanz
- Hematology Department, Hospital Universitario y Polit; Health Reserach Institute La Fe, Valencia, Spain; CIBERONC, ISCIII, Madrid, Spain
| | | | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
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9
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Szabolcs P, Mazor RD, Yackoubov D, Levy S, Stiff P, Rezvani A, Hanna R, Wagner J, Keating A, Lindemans CA, Karras N, McGuirk J, Hamerschlak N, López I, Sanz G, Valcarcel D, Horwitz ME. Immune Reconstitution Profiling Suggests Antiviral Protection After Transplantation with Omidubicel: a Phase 3 Substudy. Transplant Cell Ther 2023:S2666-6367(23)01256-3. [PMID: 37120136 DOI: 10.1016/j.jtct.2023.04.018] [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: 02/17/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative treatment for hematological malignancies and non-malignant disorders. Rapid immune reconstitution (IR) following allogeneic HCT has been shown to be associated with improved clinical outcomes and lower infection rates. A global phase 3 trial (NCT02730299) of omidubicel, an advanced cell therapy manufactured from an appropriately human leukocyte antigen-matched single umbilical cord blood (UCB) unit, showed faster hematopoietic recovery, reduced rates of infection, and shorter hospitalizations in patients randomized to omidubicel compared with those randomized to standard UCB. OBJECTIVE This optional, prospective substudy of the phase 3 trial characterized the IR kinetics following HCT with omidubicel compared with UCB in a systematic and detailed manner. STUDY DESIGN In this substudy, 37 patients from 14 global sites were included (omidubicel: n=17, UCB: n=20). Peripheral blood samples were collected over 10 predefined time points from 7 to 365 days post-HCT. Flow cytometry immunophenotyping, T cell receptor excision circle quantification, and T cell receptor sequencing were employed to evaluate the longitudinal IR kinetics post-transplant and their association with clinical outcomes. RESULTS Patient characteristics in the two comparator cohorts were overall statistically similar, except for age and total body irradiation (TBI) based conditioning regimens. The median age (range) for patients who received omidubicel or UCB was 30 (13-62) years and 43 (19-55) years, respectively. The percentages of patients receiving TBI based conditioning regimens were 47% and 70% for omidubicel and UCB recipients, respectively. Graft characteristics differed in their cellular composition. Omidubicel recipients received a 33-fold higher median dose of CD34+ stem cells, while receiving one third of the median CD3+ lymphocyte dose infused to UCB transplanted patients. Compared with UCB, omidubicel recipients exhibited faster IR of all measured lymphoid and myelomonocytic subpopulations, predominantly in the first 14 days post-transplant. This effect involved circulating natural killer (NK) cells, helper T cells, monocytes, and dendritic cells, with superior long-term B cell recovery from Day 28. One-week post-HCT, omidubicel recipients exhibited 4.1 and 7.7 -fold increases in the median helper T and NK cell counts respectively, compared to their UCB transplanted counterparts. By three weeks post-HCT, omidubicel transplanted patients were 3-fold more likely to achieve clinically relevant helper T and NK cell counts of 100 cells/ µL or above. Similar to UCB, omidubicel yielded a balanced cellular subpopulation composition and diverse T cell receptor repertoire in the short to long term. Omidubicel's CD34+ cell content correlated with faster IR by Day 7 post-HCT, which in turn coincided with earlier hematopoietic recovery. Lastly, early NK and helper T cell reconstitution correlated with a decreased rate of post-HCT viral infections, suggesting a plausible explanation for this phenomenon among omidubicel recipients in the phase 3 study. CONCLUSIONS Our findings suggest that omidubicel efficiently promotes IR across multiple immune cells, including CD4+ T cells, B cells, NK cells, and dendritic cell subtypes as early as 7 days post-transplant, potentially endowing recipients of omidubicel with early protective immunity.
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Affiliation(s)
- Paul Szabolcs
- Division of Blood and Marrow Transplantation and Cellular Therapy, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | - John Wagner
- University of Minnesota, Minneapolis, Minnesota
| | - Amy Keating
- Denver Children's Hospital, Denver, Colorado
| | | | - Nicole Karras
- City of Hope National Medical Center, Duarte, California
| | - Joseph McGuirk
- University of Kansas Medical Center, Kansas City, Kansas
| | | | - Ivan López
- Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Guillermo Sanz
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Mitchell E Horwitz
- Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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10
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Lin C, DiCioccio RA, Haykal T, McManigle WC, Li Z, Anand SM, Poe JC, Bracken SJ, Jia W, Alyea EP, Cardones AR, Choi T, Gasparetto C, Grunwald MR, Hennig T, Kang Y, Long GD, Lopez R, Martin M, Minor KK, Quinones VLP, Sung AD, Wiggins K, Chao NJ, Horwitz ME, Rizzieri DA, Sarantopoulos S. A Phase I Trial of SYK Inhibition with Fostamatinib in the Prevention and Treatment of Chronic Graft-Versus-Host Disease. Transplant Cell Ther 2023; 29:179.e1-179.e10. [PMID: 36577483 PMCID: PMC10433369 DOI: 10.1016/j.jtct.2022.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 12/26/2022]
Abstract
Despite the exciting advancement of novel therapies, chronic graft-versus-host disease (cGVHD) remains the most common cause of non-relapse mortality after allogeneic hematopoietic stem cell transplantation (HCT). Frontline treatment of cGVHD involves systemic steroids, which are associated with significant morbidities. We previously found that inhibition of spleen tyrosine kinase (SYK) with fostamatinib preferentially eradicated aberrantly activated B cells in both ex vivo studies of cGVHD patient B cells, as well as in vivo mouse studies. These and other preclinical studies implicated hyper-reactive B-cell receptor signaling and increased SYK expression in the pathogenesis of cGVHD and compelled this first in-human allogeneic HCT clinical trial. We investigated the safety and efficacy of the oral SYK inhibitor, fostamatinib, for both the prevention and treatment of cGVHD. The primary objective was to evaluate the safety of fostamatinib and determine its maximum tolerated dose in the post-HCT setting. Secondary objectives included assessing the efficacy of fostamatinib in preventing and treating cGVHD, as well as examining alterations in B-cell compartments with treatment. This was a single-institution phase I clinical trial that evaluated the use of fostamatinib in allogeneic HCT patients before the development of cGVHD or at the time of steroid-refractory cGVHD (SR-cGVHD). Patients received fostamatinib at one of three dose levels using a continual reassessment algorithm to determine the maximum tolerated dose. Multiparameter flow cytometry was used to evaluate changes in B cell subpopulations over the first year of treatment with fostamatinib. Nineteen patients were enrolled in this phase I trial, with 5 in the prophylaxis arm and 14 in the therapeutic arm. One patient (5%) required discontinuation of therapy for a dose-limiting toxicity. At a median follow-up of over 3 years, no patients had cancer relapse while on fostamatinib treatment, and recurrent malignancy was observed in 1 patient 2 years after the end of therapy. In the prophylaxis arm, 1 of 5 patients (20%) developed cGVHD while on fostamatinib. In the therapeutic arm, the overall response rate was 77%, with a complete response rate of 31%. The median duration of response was 19.3 months and the 12-month failure-free survival was 69% (95% confidence interval, 48-100). Patients were able to reduce their steroid dose by a median of 80%, with 73% remaining on a lower dose at 1 year compared to baseline. There was an early reduction in the proportion of IgD-CD38hi plasmablast-like cells with fostamatinib treatment, particularly in those SR-cGVHD patients who had an eventual response. B-cell reconstitution was not significantly impacted by fostamatinib therapy after allogeneic HCT. Fostamatinib featured a favorable safety profile in the post-HCT setting. Our data suggests an early efficacy signal that was associated with effects on expected cell targets in both the prophylaxis and treatment of cGVHD, providing rationale for a phase II investigation.
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Affiliation(s)
- Chenyu Lin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Rachel A DiCioccio
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Tarek Haykal
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - William C McManigle
- Division of Pulmonary and Critical Care, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Zhiguo Li
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sarah M Anand
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jonathan C Poe
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Sonali J Bracken
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Wei Jia
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Edwin P Alyea
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Adela R Cardones
- Division of Dermatology, Department of Internal Medicine, University of Kansas Medical Center, Lawrence, Kansas
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Therese Hennig
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Yubin Kang
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Richard Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Melissa Martin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kerry K Minor
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kristi Wiggins
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
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11
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Basher F, Visentin J, Jia W, Poe JC, Su H, Sofian C, DiCioccio R, Curry-Chisolm I, Bracken S, Ho VT, Sisirak V, Horwitz ME, Chao NJ, Sarantopoulos S. The DNA Sensor AIM2 Promotes BCR-Activated B Cells in Chronic Graft-Versus-Host-Disease. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Mazor R, Yackoubov D, Levy S, Geffen Y, Szabolcs P, Horwitz ME. Omidubicel Product Characteristics Correlate with Early and Robust Immune Reconstitution and Favorable Clinical Outcomes. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Lin C, Sajeev G, Stiff PJ, Brunstein CG, Cutler C, Sanz G, Lindemans CA, Rezvani AR, Hanna R, Koh LP, Maziarz RT, Hwang WYK, Song Y, Liu Q, Manghani R, Sivaraman S, Signorovitch J, Horwitz ME, Sung AD. Health-Related Quality of Life Following Allogeneic Hematopoietic Cell Transplantation with Omidubicel versus Umbilical Cord Blood. Transplant Cell Ther 2023; 29:52.e1-52.e9. [PMID: 36179986 PMCID: PMC9825638 DOI: 10.1016/j.jtct.2022.09.018] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/23/2022] [Indexed: 01/11/2023]
Abstract
Omidubicel is an advanced cell therapy derived from umbilical cord blood (UCB) for use in allogeneic hematopoietic cell transplantation (HCT). A recent randomized phase 3 clinical trial demonstrated faster engraftment, shorter length of hospital stays, and lower rates of infection with omidubicel compared with standard UCB transplantation in patients with high-risk hematologic malignancies. Despite the proven clinical benefits of omidubicel, its impact on health-related quality of life (HRQL) from the patient's perspective has not been described. This study analyzed patient-reported HRQL measures collected prospectively in the randomized phase 3 trial comparing omidubicel to standard UCB transplantation. A total of 108 patients at 33 international stem cell transplantation centers underwent myeloablative allogeneic HCT with either omidubicel or standard UCB. Patients completed serial HRQL questionnaires at screening and on days 42, 100, 180, and 365 post-transplantation. The HRQL surveys included the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), a 50-item cancer-specific questionnaire assessing physical, functional, emotional, social/family, and HCT-specific well-being, and the EuroQol 5-Dimension 3-Level, a 5-item generic HRQL survey. A mixed model with repeated measures was used to compare changes in HRQL from baseline in the 2 treatment arms. The average change in HRQL scores over time was compared by estimating the difference in the area under the curve (AUC) in each treatment group. Seventy-five patients (omidubicel arm, n = 37; standard UCB arm, n = 38) who completed the FACT-BMT at baseline and on 1 or more follow-up visits were included in this study. Baseline characteristics were similar in the 2 treatment arms. Over the first year post-transplantation, the AUCs of mean changes in physical, functional, and total FACT-BMT scores indicated significantly better HRQL with omidubicel (P < .05), with mean differences across time points ranging from 1.4 to 3.1 points, 1.6 to 3.2 points, and 7.2 to 11.0 points, respectively. The minimal clinically important difference was exceeded at 1 or more time points for each of these measures. The HRQL improvements with omidubicel were observed as early as 42 days post-transplantation and persisted at 1 year, indicating the potential long-term benefits of omidubicel on HRQL. Across all patients, adverse clinical outcomes, such as grade 3 viral infections and lower rates of neutrophil engraftment, were associated with worse HRQL scores. The observed improvements in HRQL measures may reflect the known clinical benefits of omidubicel. Compared with standard UCB, allogeneic HCT with omidubicel resulted in significant and clinically meaningful improvements in patient-reported HRQL measures.
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Affiliation(s)
- Chenyu Lin
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | | | - Patrick J Stiff
- Division of Hematology and Oncology, Loyola University Medical Center, Chicago, Illinois
| | - Claudio G Brunstein
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota; Department of Hematology and Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | - Corey Cutler
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Guillermo Sanz
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CICERONC, Instituto de Salud Carlos III, Madrid, Spain; IIS La Fe, Valencia, Spain
| | - Caroline A Lindemans
- Department of Pediatric Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew R Rezvani
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, California
| | - Rabi Hanna
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Liang Piu Koh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Richard T Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - William Y K Hwang
- Department of Haematology, National Cancer Centre Singapore; Department of Haematology, Singapore General Hospital; Cancer and Stem Cell Biology, Duke-NUS Medical School
| | - Yan Song
- Analysis Group, Inc, Boston, Massachusetts
| | - Qing Liu
- Analysis Group, Inc, Boston, Massachusetts
| | | | | | | | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina.
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14
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Patel P, Dillon M, Niedzwiecki D, Horwitz ME, Kelsey CR. Optimizing Management of the Central Nervous System in Patients with Acute Lymphoblastic Leukemia Undergoing Allogeneic Stem Cell Transplantation. Adv Radiat Oncol 2022; 8:101082. [PMID: 36845621 PMCID: PMC9943767 DOI: 10.1016/j.adro.2022.101082] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose To evaluate clinical outcomes and patterns of failure, specifically in regards to the central nervous system (CNS), in patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (HSCT) using total body irradiation (TBI)-based conditioning regimens. Methods and Materials All adult patients (aged ≥18 years) with ALL undergoing allogeneic HSCT using TBI-based conditioning regimens treated from 1995 to 2020 at Duke University Medical Center were evaluated. Various patient, disease, and treatment-related factors were collected, including CNS prophylaxis and treatment interventions. Clinical outcomes, including freedom from CNS relapse, were calculated using the Kaplan-Meier method for patients with and without CNS disease at presentation. Results One hundred and fifteen patients with ALL were included the analysis (myeloablative, 110; nonmyeloablative, 5). Of the 110 patients undergoing a myeloablative regimen, most (n = 100) did not have CNS disease before transplant. For this subgroup, peritransplant intrathecal chemotherapy was administered in 76% (median of 4 cycles) and 10 received a radiation boost to the CNS (cranial irradiation, 5; craniospinal, 5). Only 4 failed in the CNS after transplant, none of whom received a CNS boost, with freedom from CNS relapse at 5 years of 95% (95% confidence interval (CI), 84-98%). Freedom from CNS relapse was not improved with a radiation therapy boost to the CNS (100% vs 94%, P = .59). Overall survival, leukemia-free survival, and nonrelapse mortality at 5 years were 50%, 42%, and 36%, respectively. Among the 10 patients with CNS disease before transplant, 10 of 10 received intrathecal chemotherapy and 7 received a radiation boost to the CNS (cranial irradiation, 1; craniospinal, 6) and none subsequently failed in the CNS. A nonmyeloablative HSCT was pursued for 5 patients because of advanced age or comorbidities. None of these patients had prior CNS disease or received a CNS or testicular boost, and none failed in the CNS after transplant. Conclusions A CNS boost may not be necessary in patients with high-risk ALL without CNS disease undergoing a myeloablative HSCT using a TBI-based regimen. Favorable outcomes were observed with a low-dose craniospinal boost in patients with CNS disease.
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Affiliation(s)
- Pranalee Patel
- Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Mairead Dillon
- Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Donna Niedzwiecki
- Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E. Horwitz
- Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Chris R. Kelsey
- Departments of Radiation Oncology, Duke University Medical Center, Durham, North Carolina,Corresponding author: Chris R. Kelsey, MD
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15
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DeZern AE, Eapen M, Wu J, Talano JA, Solh M, Dávila Saldaña BJ, Karanes C, Horwitz ME, Mallhi K, Arai S, Farhadfar N, Hexner E, Westervelt P, Antin JH, Deeg HJ, Leifer E, Brodsky RA, Logan BR, Horowitz MM, Jones RJ, Pulsipher MA. Haploidentical bone marrow transplantation in patients with relapsed or refractory severe aplastic anaemia in the USA (BMT CTN 1502): a multicentre, single-arm, phase 2 trial. Lancet Haematol 2022; 9:e660-e669. [PMID: 35907408 PMCID: PMC9444987 DOI: 10.1016/s2352-3026(22)00206-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Relapsed severe aplastic anaemia is a marrow failure disorder with high morbidity and mortality. It is often treated with bone marrow transplantation at relapse post-immunosuppressive therapy, but under-represented minorities often cannot find a suitably matched donor. This study aimed to understand the 1-year overall survival in patients with relapsed or refractory severe aplastic anaemia after haploidentical bone marrow transplantation. METHODS We report the outcomes of BMT CTN 1502, a single-arm, phase 2 clinical trial done at academic bone marrow transplantation centres in the USA. Included patients were children and adults (75 years or younger) with severe aplastic anaemia that was refractory (fulfilment of severe aplastic anaemia disease criteria at least 3 months after initial immunosuppressive therapy) or relapsed (initial improvement of cytopenias after first-line immunosuppressive therapy but then a later return to fulfilment of severe aplastic anaemia disease criteria), adequate performance status (Eastern Cooperative Oncology Group score 0 or 1, Karnofsky or Lansky score ≥60%), and the presence of an eligible related haploidentical donor. The regimen used reduced-intensity conditioning (rabbit anti-thymocyte globulin 4·5 mg/kg in total, cyclophosphamide 14·5 mg/kg daily for 2 days, fludarabine 30 mg/m2 daily for 5 days, total body irradiation 200 cGy in a single fraction), related HLA-haploidentical donors, and post-transplantation cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis. Additionally, for GVHD prophylaxis, mycophenolate mofetil was given orally at a dose of 15 mg/kg three times a day up to 1 g three times a day (maximum dose 3000 mg per day) from day 5 to day 35, and tacrolimus was given orally or intravenously from day 5 to day 180 as per institutional standards to maintain a serum concentration of 10-15 ng/mL. The primary endpoint was overall survival 1 year after bone marrow transplantation. All patients treated per protocol were analysed. This study is complete and is registered with ClinicalTrials.gov, NCT02918292. FINDINGS Between May 1, 2017, and Aug 30, 2020, 32 patients with relapsed or refractory severe aplastic anaemia were enrolled from 14 centres, and 31 underwent bone marrow transplantation. The median age was 24·9 years (IQR 10·4-51·3), and median follow-up was 24·3 months (IQR 12·1-29·2). Of the 31 patients who received a transplant, 19 (61%) were male and 12 (39%) female. 13 (42%) patients were site-reported as non-White, and 19 (61%) were from under-represented racial and ethnic groups; there were four (13%) patients who were Asian, seven (23%) Black, one (3%) Hawaiian/Pacific Islander, and one (3%) more than one race, with seven (23%) patients reporting Hispanic ethnicity. 24 (77%) of 31 patients were alive with engraftment at 1 year, and one (3%) patient alive with autologous recovery. The 1-year overall survival was 81% (95% CI 62-91). The most common grade 3-5 adverse events (seen in seven or more patients) included seven (23%) patients with abnormal liver tests, 15 (48%) patients with cardiovascular changes (including sinus tachycardia, heart failure, pericarditis), ten (32%) patients with gastrointestinal issues, seven (23%) patients with nutritional disorders, and eight (26%) patients with respiratory disorders. Six (19%) deaths, due to disease and unsuccessful bone marrow transplantation, were reported after transplantation. INTERPRETATION Haploidentical bone marrow transplantation using this approach results in excellent overall survival with minimal GVHD in patients who have not responded to immunosuppressive therapy, and can expand access to bone marrow transplantation across all populations. In clinical practice, this could now be considered a standard approach for salvage treatment of severe aplastic anaemia. Attention to obtaining high cell doses (>2·5 × 108 nucleated marrow cells per kg of recipient ideal bodyweight) from bone marrow harvests is crucial to the success of this approach. FUNDING US National Heart, Lung, and Blood Institute and US National Cancer Institute.
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Affiliation(s)
- Amy E DeZern
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
| | - Mary Eapen
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Juan Wu
- The EMMES Company, Rockville, MD, USA
| | - Julie-An Talano
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | | | | | | | - Sally Arai
- Blood and Marrow Transplantation and Cellular Therapy Division, Stanford University, Stanford, CA, USA
| | - Nosha Farhadfar
- UF Health Bone Marrow Transplant, University of Florida, Gainesville, FL, USA
| | - Elizabeth Hexner
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | | | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Eric Leifer
- Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Robert A Brodsky
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Brent R Logan
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mary M Horowitz
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard J Jones
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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Lew MV, Ren Y, Lowder YP, Siamakpour-Reihani S, Ramalingam S, Romero KM, Thompson JC, Bohannon LM, McIntyre J, Tang H, Van Opstal J, Johnson E, Cohen HJ, Bartlett DB, Pastva AM, Morey M, Hall KS, Smith P, Peters KB, Somers TJ, Kelleher S, Smith SK, Wischmeyer PE, Lin PH, Wood WA, Thorpe G, Minor K, Wiggins K, Hennig T, Helms T, Welch R, Matthews B, Liu J, Burleson J, Aberant T, Engemann AK, Henshall B, Darby M, Proch C, Dellascio M, Pittman A, Suminguit J, Choi T, Gasparetto C, Long GD, Lopez RD, Sarantopoulos S, Horwitz ME, Chao NJ, Sung AD. Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years. Transplant Cell Ther 2022; 28:498.e1-498.e9. [PMID: 35595226 PMCID: PMC10042624 DOI: 10.1016/j.jtct.2022.05.018] [Citation(s) in RCA: 4] [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: 02/23/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for both malignant and nonmalignant hematologic diseases; however, reported rates of treatment-related mortality approach 30%. Outcomes are worse in patients who begin HCT with functional impairments. To detect such impairments, a geriatric assessment (GA) is recommended in adults age ≥65 years. Younger HCT candidates also may be impaired because of chemotherapy regimens pre-HCT. Therefore, we hypothesized that GA can be beneficial for adult patients of all ages and subsequently created a clinical pretransplantation optimization program to assess all HCT candidates using a modified GA. One-hundred fifty-seven patients were evaluated in 4 functional domains- physical, cognitive, nutritional, and psychological-at 2 time points prior to HCT-new patient evaluation (NPE) and sign-off (SO)-between October 2017 and January 2020. At NPE, 80.9% of the patients had at least 1 domain with a functional impairment, and physical (P = .006), cognitive (P = .04), and psychological (P = .04) impairments were associated with an increased likelihood of not proceeding to HCT. In addition, patients age 18 to 39 years were more likely than older patients to have a physical function impairment (P = .001). Between NPE and SO, 51.9% of the patients had resolution of 1 or more impairments, and nutritional impairment at SO was predictive of worse overall survival (P = .01). Our study shows that GA can identify functional impairments in patients of all ages. Early identification of impairments could facilitate referrals to supportive care and resolution of impairments prior to HCT, suggesting that GA could be recommended for HCT candidates of all ages.
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Affiliation(s)
- Meagan V Lew
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Yi Ren
- Duke Cancer Institute Biostatistics Shared Resources, Durham, North Carolina
| | - Yen P Lowder
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Sharareh Siamakpour-Reihani
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Sendhilnathan Ramalingam
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | | | - Jillian C Thompson
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Lauren M Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Jackie McIntyre
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Helen Tang
- Duke University School of Medicine, Durham, North Carolina
| | - Jolien Van Opstal
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina; Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Ernaya Johnson
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Harvey Jay Cohen
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - David B Bartlett
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina; School of Biosciences and Medicine, University of Surrey, Surrey, United Kingdom
| | - Amy M Pastva
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina; Department of Orthopedic Surgery, Division of Physical Therapy, Duke University Medical Center, Durham, North Carolina
| | - Miriam Morey
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina; Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina
| | - Katherine S Hall
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina; Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina
| | - Patrick Smith
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Katherine B Peters
- Departments of Neurology and Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina
| | - Tamara J Somers
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Sarah Kelleher
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Sophia K Smith
- School of Nursing, Duke University Medical Center, Durham, North Carolina
| | - Paul E Wischmeyer
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Pao-Hwa Lin
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - William A Wood
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Glynnis Thorpe
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Kerry Minor
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Kristi Wiggins
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Therese Hennig
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Tanya Helms
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Renee Welch
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Brittany Matthews
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - JoAnn Liu
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Jill Burleson
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Thomas Aberant
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Ashley K Engemann
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Bethany Henshall
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Maurisa Darby
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Christina Proch
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Michelle Dellascio
- Duke Health Department of Physical Therapy and Occupational Therapy, Durham, North Carolina
| | - Alyssa Pittman
- Duke Health Department of Physical Therapy and Occupational Therapy, Durham, North Carolina
| | - Jacob Suminguit
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Richard D Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina; Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.
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17
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Brunstein CG, O’Donnell PV, Logan B, Dawson P, Costa L, Cutler C, Craig M, Hogan W, Horowitz MM, Horwitz ME, Karanes C, Magenau JM, Malone A, McCarty J, McGuirk JP, Morris LE, Rezvani AR, Salit R, Vasu S, Eapen M, Fuchs EJ. Impact of Center Experience with Donor Type on Outcomes: A Secondary Analysis, Blood and Marrow Transplant Clinical Trials Network 1101Open for Accrual June 2012Open for Accrual June 2012. Transplant Cell Ther 2022; 28:406.e1-406.e6. [PMID: 35390529 PMCID: PMC9253061 DOI: 10.1016/j.jtct.2022.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
We previously reported the results of Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 1101, a randomized comparison of hematopoietic cell transplantation (HCT) performed with double umbilical cord blood units (dUCB) or with haploidentical bone marrow (haplo-BMT) with post-transplantation cyclophosphamide (PTCy) in the nonmyeloablative setting. Those results showed similar progression-free survival in the 2 treatment groups but lower nonrelapse mortality and better overall survival in the haplo-BM arm. In this secondary analysis, we sought to investigate whether transplantation center's previous experience with haplo-BM and/or dUCB HCT had an impact on outcomes. All patients randomized in BMT CTN 1101 were included. Center experience was assigned based on the number of transplantations with each platform performed in the year before initiation of the study according to the Center for International Blood and Marrow Transplant Research. Centers were then classified as a dUCB center (>10 dUCB HCTs; n = 117 patients, 10 centers), a haplo-BM center (>10 haplo-BM HCTs and ≤10 dUCB HCTs; n = 110 patients, 2 centers), or other center (≤10 haplo and ≤10 dUCB HCTs; n = 140 patients, 21 centers). After adjusting for age, Karnofsky Performance Status, and Disease Risk Index, we found that haplo-BM centers had lower overall mortality with this donor type compared with dUCB centers (hazard ratio [HR], 2.56; 95% confidence interval [CI], 1.44 to 4.56). In contrast, there were no differences in overall mortality between haplo-BM and dUCB in centers that were experienced with dUCB HCT (HR, 1.02; 95% CI, .59 to 1.79) or had limited to no experience with either dUCB or haplo-BM HCT (HR, 1.36; 95% CI, .83 to 2.21). The higher risk of treatment failure and overall mortality in dUCB HCT in haplo BM-experienced centers was driven by a significantly higher risk of relapse (HR, 1.78; 95% CI, 1.07 to 2.97). With the exception of worse outcomes among dUCB HCT recipients in haplo-BM centers, transplantation center experience in the year before initiation of BMT CTN 1101 had a limited impact on the outcomes of this randomized clinical trial.
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Affiliation(s)
- Claudio G Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Mayo Mail Code 480, 420 Delaware Street SE, Minneapolis, MN 55455, United States.
| | | | - Brent Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Corey Cutler
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | | | | | | | | | | | - Rachel Salit
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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18
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Sung AD, Giri VK, Tang H, Nichols KR, Lew MV, Bohannon L, Ren Y, Jung SH, Dalton T, Bush A, Van Opstal J, Artica A, Messina J, Shelby R, Frith J, Lassiter M, Burleson J, Leonard K, Potter AS, Choi T, Gasparetto CJ, Horwitz ME, Long GD, Lopez RD, Sarantopoulos S, Chao NJ. Home-Based Hematopoietic Cell Transplantation in the United States. Transplant Cell Ther 2022; 28:207.e1-207.e8. [PMID: 35066211 PMCID: PMC8977260 DOI: 10.1016/j.jtct.2022.01.015] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 01/25/2023]
Abstract
Patients undergoing allogeneic (allo) and autologous (auto) hematopoietic cell transplantation (HCT) require extensive hospitalizations or daily clinic visits for the duration of their transplantation. Home HCT, wherein patients live at home and providers make daily trips to the patient's residence to perform assessments and deliver any necessary interventions, may enhance patient quality of life and improve outcomes. We conducted the first study of home HCT in the United States to evaluate this model in the US healthcare setting and to determine the effect on clinical outcomes and quality of life. This case-control study evaluated patients who received home HCT at Duke University in Durham, North Carolina, from November 2012 to March 2018. Each home HCT patient was matched with 2 controls from the same institution who had received standard treatment based on age, disease, and type of transplant for outcomes comparison. Clinical outcomes were abstracted from electronic health records, and quality of life was assessed via Functional Assessment of Cancer Therapy-Bone Marrow Transplant. Clinical outcomes were compared with Student's t-test or Fisher's exact test (continuous variables) or chi-square test (categorical variables). Quality of life scores were compared using the Student t-test. All analyses used a significance threshold of 0.05. Twenty-five patients received home HCT, including 8 allos and 17 autos. Clinical outcomes were not significantly different between the home HCT patients and their matched controls; home HCT patients had decreased incidence of relapse within 1 year of transplantation. Pre-HCT quality of life was well preserved for autologous home HCT patients. This Phase I study demonstrated that home HCT can be successfully implemented in the United States. There was no evidence that home HCT outcomes were inferior to standard-of-care treatment, and patients undergoing autologous home HCT were able to maintain their quality of life. A Phase II randomized trial of home versus standard HCT is currently underway to better compare outcomes and costs.
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Affiliation(s)
- Anthony D. Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Durham, NC, USA
| | - Vinay K. Giri
- Stanford Department of Internal Medicine, Stanford, CA, USA
| | - Helen Tang
- Duke University School of Medicine, Durham, NC, USA
| | - Krista Rowe Nichols
- Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Meagan V. Lew
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Lauren Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Yi Ren
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Sin-Ho Jung
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Tara Dalton
- Duke University School of Medicine, Durham, NC, USA
| | - Amy Bush
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Jolien Van Opstal
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Alexandra Artica
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Julia Messina
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Rebecca Shelby
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer Frith
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Martha Lassiter
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Jill Burleson
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Kari Leonard
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Ashley S. Potter
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Cristina J. Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Mitchell E. Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Gwynn D. Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Richard D. Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Nelson J. Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
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Szabolcs P, Chen X, Yackoubov D, Levy S, Horwitz ME. Hematopoietic Stem Cell Transplantation (HSCT) with Omidubicel Is Associated with Enhanced Circulatory Plasmacytoid Dendritic Cells (pDC), NK Cells and CD4+ T Cells with Lower Rates of Severe Infections Compared to Standard Umbilical Cord Blood Transplantation. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lin C, Morrison L, Alyea EP, Choi T, Gasparetto C, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Sung A, Chao NJ, Galamidi-Cohen E, Schwarzbach A, Horwitz ME. Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) with Omidubicel: Long-Term Follow-up from a Single Center. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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McDaniel R, Horwitz ME, Garrett R. An Agile Approach to ABMT Data & Workflow Innovation during a Pandemic. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00269-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Horwitz ME, Stiff P, Cutler C, Brunstein CG, Rezvani AR, Hanna R, Khee Hwang WY, Maziarz RT, McGuirk JP, Karras N, Lindemans CA, Valcarcel D, Koh LP, Schiller GJ, Sanz J, Schwarzbach A, Galamidi-Cohen E, Sanz G. Allogeneic Hematopoietic Stem Cell (Allo-HSCT) Transplant with Omidubicel Demonstrates Sustained Clinical Improvement Versus Standard Myeloablative Umbilical Cord Blood Transplantation (UCBT): Final Results of a Phase III Randomized, Multicenter Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Horwitz ME, Sajeev G, Stiff P, Brunstein CG, Cutler C, Sanz G, Lindemans CA, Rezvani AR, Hanna R, Koh LP, Maziarz RT, Khee Hwang WY, Song Y, Liu Q, Manghani R, Sivaraman S, Signorovitch J, Galamidi-Cohen E. Health-Related Quality of Life (HRQL) Following Transplantation with Omidubicel Versus Umbilical Cord Blood (UCB) in Patients with Hematologic Malignancies: Results from a Phase III Randomized, Multicenter Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mallee J, Horwitz ME, Briggs A, Anand S, Tey SK, Waller EK, Cooper M, Baheti G, Mahajan V, Lee L, Deeg HJ. MODULAATE, A 2-Part, Dose-Finding, Efficacy and Safety Trial with Alpha-1 Antitrypsin (AAT) for Prevention of Acute Graft vs. Host Disease (aGVHD): Part 1 Safety and Pharmacokinetic (PK) Results. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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de Koning C, Tao W, Lacna A, van Veghel K, Horwitz ME, Sanz G, Jagasia MH, Wagner JE, Stiff PJ, Hanna R, Cilloni D, Valcárcel D, Peled T, Galamidi Cohen E, Goshen U, Pandit A, Lindemans CA, Jan Boelens J, Nierkens S. Lymphoid and myeloid immune cell reconstitution after nicotinamide-expanded cord blood transplantation. Bone Marrow Transplant 2021; 56:2826-2833. [PMID: 34312498 PMCID: PMC8563413 DOI: 10.1038/s41409-021-01417-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Omidubicel (nicotinamide-expanded cord blood) is a potential alternative source for allogeneic hematopoietic cell transplantation (HCT) when an HLA-identical donor is lacking. A phase I/II trial with standalone omidubicel HCT showed rapid and robust neutrophil and platelet engraftment. In this study, we evaluated the immune reconstitution (IR) of patients receiving omidubicel grafts during the first 6 months post-transplant, as IR is critical for favorable outcomes of the procedure. Data was collected from the omidubicel phase I-II international, multicenter trial. The primary endpoint was the probability of achieving adequate CD4+ T-cell IR (CD4IR: > 50 × 106/L within 100 days). Secondary endpoints were the recovery of T-cells, natural killer (NK)-cells, B-cells, dendritic cells (DC), and monocytes as determined with multicolor flow cytometry. LOESS-regression curves and cumulative incidence plots were used for data description. Thirty-six omidubicel recipients (median 44; 13-63 years) were included, and IR data was available from 28 recipients. Of these patients, 90% achieved adequate CD4IR. Overall, IR was complete and consisted of T-cell, monocyte, DC, and notably fast NK- and B-cell reconstitution, compared to conventional grafts. Our data show that transplantation of adolescent and adult patients with omidubicel results in full and broad IR, which is comparable with IR after HCT with conventional graft sources.
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Affiliation(s)
- Coco de Koning
- University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Weiyang Tao
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Amelia Lacna
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Guillermo Sanz
- Hospital Universitario y Politécnico la Fe, València, Spain
- Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Caroline A Lindemans
- University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jaap Jan Boelens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefan Nierkens
- University Medical Center Utrecht, Utrecht, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
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26
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Ponce DM, Politikos I, Alousi A, Carpenter PA, Milano F, MacMillan ML, Barker JN, Horwitz ME. Guidelines for the Prevention and Management of Graft-versus-Host Disease after Cord Blood Transplantation. Transplant Cell Ther 2021; 27:540-544. [PMID: 34210500 DOI: 10.1016/j.jtct.2021.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 12/13/2022]
Abstract
The incidence of graft-versus-host disease (GVHD) after cord blood (CB) transplantation (CBT) is lower than expected given the marked degree of human leukocyte antigen (HLA)-mismatch of CB grafts. While the exact mechanism that underlies this biology remains unclear, it is hypothesized to be due to the low number of mostly immature T-cells infused as part of the graft1,2, and increased tolerance of CB-derived lymphocytes induced by the state of pregnancy. Nevertheless, acute GVHD (aGVHD) is a significant complication of CBT. In contrast, the incidence of chronic GVHD (cGVHD) following CBT is lower than what is observed following matched related or unrelated donor HSC transplantation (HSCT)3-6. This review outlines the guidelines for the prevention and management of acute and chronic GVHD following CBT.
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Affiliation(s)
- Doris M Ponce
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College; New York, New York.
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College; New York, New York
| | - Amin Alousi
- Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul A Carpenter
- Fred Hutchinson Cancer Research Center, Division of Clinical Research, Department of Pediatrics, Seattle, Washington
| | - Filippo Milano
- Fred Hutchinson Cancer Research Center, Department of Oncology, Seattle, Washington
| | - Margaret L MacMillan
- Blood and Marrow Transplantation & Cellular Therapy Program, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College; New York, New York
| | - Mitchell E Horwitz
- Hematologic Malignancies and Cellular Therapies, Department of Medicine, Duke Cancer Institute, Durham, North Carolina
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Islam P, Tang H, Jin H, Cao F, Bohannon LM, Ren Y, Chao NJ, Choi T, Gasparetto C, Horwitz ME, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Sung AD. Female Sex Is Associated with Improved Long-Term Survival Following Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2021; 27:784.e1-784.e7. [PMID: 34146734 DOI: 10.1016/j.jtct.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
Life expectancy for long-term survivors of allogeneic hematopoietic stem cell transplantation (alloHSCT), defined as those living ≥5 years post-transplantation, is significantly lower compared with that of the age-matched general population despite a relatively low primary disease relapse rate at >2 years post-transplantation. Among several factors, patient sex is increasingly recognized as a prognostic indicator of long-term survival. We examined the influence of patient sex and donor-recipient sex matching on overall survival (OS) in a landmark analysis of long-term survivors. Using our institutional database supplemented with individual patient record review, we retrospectively investigated the relative influence of recipient sex and donor-recipient sex matching on outcomes of long-term survivors of alloHSCT between 1994 and 2014. Over this 20-year period, 247 met inclusion criteria for analysis; males and females had similar demographic and treatment characteristics. However, significantly more deaths after the 5-year landmark occurred in male recipients. Interestingly, donor sex did not have a significant impact on OS in multivariate analysis, and differences in OS of donor-recipient sex pairs was driven by recipient sex. In addition to recipient sex, only chronic graft-versus-host disease (cGVHD) retained significance as a covariate with an impact on OS in multivariate analysis. Men experienced slightly higher, but statistically nonsignificant, rates and increased severity of cGVHD, and had higher cGVHD-related mortality compared with females. In this long-term survival analysis of adult alloHSCT recipients, one of the only to include follow-up to 15 years, our results show that women survive significantly longer than men irrespective of their age at transplantation. This outcome is independent of other common pretransplantation prognostic indicators, such as donor sex or performance status at transplantation. The inferior survival in males is consistent with survival outcomes described in the transplantation literature. Increasing evidence suggests a biological basis for long-term sex-determined outcomes, possibly owing to differing rates or severity of cGVHD or sustained alloimmune tolerance in females. Larger studies are warranted to validate these retrospective clinical results.
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Affiliation(s)
- Prioty Islam
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Helen Tang
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Haesu Jin
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Felicia Cao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Lauren M Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Yi Ren
- Duke Cancer Institute, Biostatistics Shared Resources, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Richard D Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina.
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Pabon CM, Li Z, Hennig T, de Castro C, Neff JL, Horwitz ME, LeBlanc TW, Long GD, Lopez RD, Sung AD, Chao N, Gasparetto C, Sarantopoulos S, Adams DB, Erba H, Rizzieri DA. Morphologic leukemia-free state in acute myeloid leukemia is sufficient for successful allogeneic hematopoietic stem cell transplant. Blood Cancer J 2021; 11:92. [PMID: 33994546 PMCID: PMC8126559 DOI: 10.1038/s41408-021-00481-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/05/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Cindy M Pabon
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Zhiguo Li
- Department of Biostatistics and Bioinfomatics, Duke University, Durham, NC, USA
| | - Therese Hennig
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Carlos de Castro
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Jadee L Neff
- Department of Pathology, Divisions of Hematopathology and Molecular Pathology, Genetics and Genomics, Durham, NC, USA
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Richard D Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Nelson Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Donna B Adams
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Harry Erba
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Sung AD, Miller HM, Romero K, MacDonald G, Bohannon L, Molinger J, Ren Y, Bush A, Lew M, Cohen HJ, Pastva A, Jung SH, Shah NR, Smith PJ, Wischmeyer PE, Wood WA, Alyea E, Choi T, Gasparetto C, Horwitz ME, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Sullivan KM, Chao NJ, Bartlett DB. A Phase 1 Study of the Safety and Feasibility of Improving Cardiorespiratory Fitness through a Remotely Monitored, Mobile Health Supported High Intensity Interval Training Program (REMM-HIIT). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Scott BL, Pasquini MC, Fei M, Fraser R, Wu J, Devine SM, Porter DL, Maziarz RT, Warlick E, Fernandez HF, Soiffer RJ, Alyea E, Hamadani M, Bashey A, Giralt S, Geller NL, Leifer E, Hourigan CS, Gui G, Mendizabal A, Horowitz MM, Deeg HJ, Horwitz ME. Myeloablative versus Reduced-Intensity Conditioning for Hematopoietic Cell Transplantation in Acute Myelogenous Leukemia and Myelodysplastic Syndromes-Long-Term Follow-Up of the BMT CTN 0901 Clinical Trial. Transplant Cell Ther 2021; 27:483.e1-483.e6. [PMID: 33775615 DOI: 10.1016/j.jtct.2021.02.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Abstract
Several prospective randomized trials comparing conditioning intensity before allogeneic hematopoietic cell transplantation (HCT) have been performed, with conflicting results. Although reduced-intensity conditioning (RIC) leads to lower treatment-related mortality (TRM), this is offset by higher rates of relapse. Long-term follow-up of randomized comparative trials are limited. Here we present long-term follow-up of a randomized comparison of myeloablative conditioning (MAC) compared with RIC before HCT for acute myelogenous leukemia (AML) or myelodysplasia (MDS). Long-term comparative analyses of overall survival, relapse, and relapse-free survival were performed. Patients age 18 to 65 years with <5% marrow myeloblasts were randomized to receive MAC (n = 135) or RIC (n = 137), followed by HCT from an HLA-matched donor. The primary endpoint of the trial was an 18-month pointwise comparison of overall survival. The analyses were performed using a proportional hazards model. The median follow-up of the entire cohort was 51 months. At 4 years, the transplant-related mortality (TRM) was 25.1% for MAC, compared with 9.9% for RIC (P < .001). Patients who received RIC had a significantly higher risk of relapse compared to those who received MAC (hazard ratio [HR], 4.06; 95% CI, 2.59 to 6.35; P < 0.001). Among the patients who relapsed after HCT, postrelapse survival was similar at 3 years (24% for MAC and 26% for RIC). Overall survival was superior for patients who received MAC compared to those who received RIC (HR, 1.54; 95% CI, 1.07 to 2.2; P = .03). Our data show that patients who received MAC were at higher risk of late TRM compared with those who received RIC; however, because of the exceedingly high rates of relapse in the RIC arm, overall survival remained significantly better for patients who received MAC. Among patients with MDS or AML eligible for either MAC or RIC regimens, long-term follow up demonstrates a survival advantage for patients who received MAC.
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Affiliation(s)
- Bart L Scott
- Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Marcelo C Pasquini
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mingwei Fei
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Raphael Fraser
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Juan Wu
- The Emmes Corporation, Rockville, Maryland
| | - Steve M Devine
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | | | | | | | | | | | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Asad Bashey
- Northside Hospital Cancer Institute, Atlanta, Georgia
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy L Geller
- National Heart Lung and Blood Institute, Bethesda, Maryland
| | - Eric Leifer
- National Heart Lung and Blood Institute, Bethesda, Maryland
| | | | - Gege Gui
- National Heart Lung and Blood Institute, Bethesda, Maryland
| | | | - Mary M Horowitz
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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Racioppi A, Dalton T, Ramalingam S, Romero K, Ren Y, Bohannon L, Arellano C, Jonassaint J, Miller H, Barak I, Fish LJ, Choi T, Gasparetto C, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Horwitz ME, Chao NJ, Shah NR, Sung AD. Assessing the Feasibility of a Novel mHealth App in Hematopoietic Stem Cell Transplant Patients. Transplant Cell Ther 2021; 27:181.e1-181.e9. [PMID: 33830035 PMCID: PMC10522407 DOI: 10.1016/j.jtct.2020.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/03/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/22/2022]
Abstract
Hematopoietic stem cell transplantation (HCT) is a curative treatment option for patients with hematologic conditions but presents many complications that must be managed as a complex, chronic condition. Mobile health applications (mHealth apps) may permit tracking of symptoms in HCT. In seeking strategies to manage the complexities of HCT, our team collaborated with Sicklesoft, Inc., to develop an mHealth app specifically for HCT patients to allow for daily evaluation of patient health, Technology Recordings to better Understand Bone Marrow Transplantation (TRU-BMT). The primary value of this application is that of potentially enhancing the monitoring of symptoms and general health of patients undergoing HCT, with the ultimate goal of allowing earlier detection of adverse events, earlier intervention, and improving outcomes. To first evaluate patient interest in mHealth apps, we designed and administered an interest survey to patients at the 2017 BMT-InfoNet reunion. As a follow-up to the positive feedback received, we began testing the TRU-BMT app in a Phase 1 pilot study. Thirty patients were enrolled in this single-arm study and were given the TRU-BMT mHealth app on a smartphone device in addition to a wearable activity tracker. Patients were followed for up to 180 days, all the while receiving daily app monitoring. Adherence to TRU-BMT was approximately 30% daily and 44% weekly, and greater adherence was associated with increased meal completion, decreased heart rate, and shorter hospital stay. TRU-BMT assessments of symptom severity were significantly associated with duration of hospital stay and development of chronic graft-versus-host disease. Our findings suggest that using TRU-BMT throughout HCT is feasible for patients and established a proof-of-concept for a future randomized control trial of the TRU-BMT application in HCT. © 2021 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Affiliation(s)
- Alessandro Racioppi
- Duke University School of Medicine, Durham, North Carolina; Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Tara Dalton
- Duke University School of Medicine, Durham, North Carolina
| | - Sendhilnathan Ramalingam
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Kristi Romero
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina
| | - Yi Ren
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Lauren Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Consuelo Arellano
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
| | - Jude Jonassaint
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Hilary Miller
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Ian Barak
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Laura J Fish
- Family Medicine and Community Health, Duke University Medical Center, Durham, North, Carolina
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Richard D Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nirmish R Shah
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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32
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Dillon LW, Gui G, Logan BR, Fei M, Ghannam J, Li Y, Licon A, Alyea EP, Bashey A, Devine SM, Fernandez HF, Giralt S, Hamadani M, Howard A, Maziarz RT, Porter DL, Warlick ED, Pasquini MC, Scott BL, Horwitz ME, Deeg HJ, Hourigan CS. Impact of Conditioning Intensity and Genomics on Relapse After Allogeneic Transplantation for Patients With Myelodysplastic Syndrome. JCO Precis Oncol 2021; 5:PO.20.00355. [PMID: 34036237 PMCID: PMC8140814 DOI: 10.1200/po.20.00355] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/09/2020] [Accepted: 12/14/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Patients with myelodysplastic syndrome (MDS) are at risk of relapse after allogeneic hematopoietic cell transplantation. The utility of ultra-deep genomic testing to predict and the impact of conditioning intensity to prevent MDS relapse are unknown. METHODS Targeted error-corrected DNA sequencing was performed on preconditioning blood samples from patients with MDS (n = 48) from the Blood and Marrow Transplant Clinical Trials Network 0901 phase III randomized clinical trial, which compared outcomes by allogeneic hematopoietic cell transplantation conditioning intensity in adult patients with < 5% marrow myeloblasts and no leukemic myeloblasts in blood on morphological analysis at the time of pretransplant assessment. Clinical end points (53-month median follow-up) included transplant-related mortality (TRM), relapse, relapse-free survival (RFS), and overall survival (OS). Of the 48 patients examined, 14 experienced TRM, 23 are relapse-free, and 11 relapsed, of which 7 died. RESULTS Using a previously described set of 10 gene regions, 42% of patients (n = 20) had mutations detectable before random assignment to reduced intensity conditioning (RIC) or myeloablative conditioning (MAC). Testing positive was associated with increased rates of relapse (3-year relapse, 40% v 11%; P = .022) and decreased OS (3-year OS, 55% v 79%, P = .045). In those testing positive, relapse rates were higher (3-year relapse, 75% v 17%; P = .003) and RFS was lower (3-year RFS, 13% v 49%; P = .003) in RIC versus MAC arms. Testing additional genes, including those associated with MDS, did not improve prognostication. CONCLUSION This study provides evidence that targeted DNA sequencing in patients with MDS before transplant can identify those with highest post-transplant relapse rates. In those testing positive, random assignment to MAC lowered but did not eliminate relapse risk.
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Affiliation(s)
- Laura W. Dillon
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Gege Gui
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Jack Ghannam
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Yuesheng Li
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | - Steven M. Devine
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alan Howard
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Richard T. Maziarz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | - Christopher S. Hourigan
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Fuchs EJ, O'Donnell PV, Eapen M, Logan B, Antin JH, Dawson P, Devine S, Horowitz MM, Horwitz ME, Karanes C, Leifer E, Magenau JM, McGuirk JP, Morris LE, Rezvani AR, Jones RJ, Brunstein CG. Double unrelated umbilical cord blood vs HLA-haploidentical bone marrow transplantation: the BMT CTN 1101 trial. Blood 2021; 137:420-428. [PMID: 33475736 PMCID: PMC7819761 DOI: 10.1182/blood.2020007535] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/16/2020] [Indexed: 12/11/2022] Open
Abstract
Results of 2 parallel phase 2 trials of transplantation of unrelated umbilical cord blood (UCB) or bone marrow (BM) from HLA-haploidentical relatives provided equipoise for direct comparison of these donor sources. Between June 2012 and June 2018, 368 patients aged 18 to 70 years with chemotherapy-sensitive lymphoma or acute leukemia in remission were randomly assigned to undergo UCB (n = 186) or haploidentical (n = 182) transplant. Reduced-intensity conditioning comprised total-body irradiation with cyclophosphamide and fludarabine for both donor types. Graft-versus-host disease prophylaxis for UCB transplantation was cyclosporine and mycophenolate mofetil (MMF) and for haploidentical transplantation, posttransplant cyclophosphamide, tacrolimus, and MMF. The primary end point was 2-year progression-free survival (PFS). Treatment groups had similar age, sex, self-reported ethnic origin, performance status, disease, and disease status at randomization. Two-year PFS was 35% (95% confidence interval [CI], 28% to 42%) compared with 41% (95% CI, 34% to 48%) after UCB and haploidentical transplants, respectively (P = .41). Prespecified analysis of secondary end points recorded higher 2-year nonrelapse mortality after UCB, 18% (95% CI, 13% to 24%), compared with haploidentical transplantation, 11% (95% CI, 6% to 16%), P = .04. This led to lower 2-year overall survival (OS) after UCB compared with haploidentical transplantation, 46% (95% CI, 38-53) and 57% (95% CI 49% to 64%), respectively (P = .04). The trial did not demonstrate a statistically significant difference in the primary end point, 2-year PFS, between the donor sources. Although both donor sources extend access to reduced-intensity transplantation, analyses of secondary end points, including OS, favor haploidentical BM donors. This trial was registered at www.clinicaltrials.gov as #NCT01597778.
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Affiliation(s)
- Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Paul V O'Donnell
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, and
| | - Brent Logan
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Joseph H Antin
- Department of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, and
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Chatchada Karanes
- Department of Hematology/Hematopoietic Cell Transplantation (HCT), City of Hope National Medical Center, Duarte, CA
| | - Eric Leifer
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - John M Magenau
- Michigan Medicine Bone Marrow Transplant and Leukemia, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Joseph P McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS
| | - Lawrence E Morris
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, GA
| | - Andrew R Rezvani
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University Medical Center, Stanford, CA; and
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Claudio G Brunstein
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
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34
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Maung KK, Chen BJ, Barak I, Li Z, Rizzieri DA, Gasparetto C, Sullivan KM, Long GD, Engemann AM, Waters-Pick B, Nichols KR, Lopez R, Kang Y, Sarantopoulos S, Sung AD, Chao NJ, Horwitz ME. Phase I dose escalation study of naive T-cell depleted donor lymphocyte infusion following allogeneic stem cell transplantation. Bone Marrow Transplant 2021; 56:137-143. [PMID: 32624583 PMCID: PMC10805111 DOI: 10.1038/s41409-020-0991-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/10/2020] [Accepted: 06/25/2020] [Indexed: 11/09/2022]
Abstract
Prophylactic donor lymphocyte infusions (DLI) are used to augment post-transplant immune recovery to reduce both infectious complications and disease recurrence. Preclinical studies implicate the naive T-cell subset as the primary driver of graft-versus-host disease (GvHD). In this phase I dose escalation study, we assessed the safety of a DLI that was depleted of CD45RA+ naive T cells. Sixteen adult patients received a prophylactic DLI at a median of 113 days (range 76-280 days) following an HLA-identical, non-myeloablative allogeneic hematopoietic stem cell transplantation. Three patients each received the naive T-cell depleted DLI with a CD3+ dose of 1 × 105/kg, 1 × 106/kg, and 5 × 106/kg. The maximum dose of 1 × 107/kg was expanded to 7 patients. No dose-limiting grade III/IV acute GvHD or adverse events attributable to the DLI were observed at any dose level. One patient developed grade 2 acute GvHD of skin and upper intestines, and another developed moderate chronic GvHD of the lungs following the DLI. With a median follow-up of 2.8 years, 2-year progression-free and overall survival is 50.0% and 68.8%, respectively. In conclusion, these data suggest that a DLI that has been depleted of CD45RA+ naive T cells is feasible and carries a low risk of acute or chronic GvHD.
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Affiliation(s)
- Ko K Maung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Benny J Chen
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Ian Barak
- Cancer Center Biostatistics, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Zhiguo Li
- Cancer Center Biostatistics, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Ashley M Engemann
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Barbara Waters-Pick
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Krista Rowe Nichols
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Richard Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Yubin Kang
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA.
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Scaradavou A, Avecilla ST, Tonon J, Politikos I, Horwitz ME, Kurtzberg J, Milano F, Barker JN. Guidelines for Cord Blood Unit Thaw and Infusion. Biol Blood Marrow Transplant 2020; 26:1780-1783. [PMID: 32599214 DOI: 10.1016/j.bbmt.2020.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Scott T Avecilla
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joann Tonon
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mitchell E Horwitz
- Adult Blood and Marrow Transplant Program, Duke University Medical Center, Durham, North Carolina
| | - Joanne Kurtzberg
- Pediatric Blood and Marrow Transplant Program, Duke University Medical Center, Durham, North Carolina; Carolinas Cord Blood Bank, Durham, North Carolina
| | - Filippo Milano
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Smith P, Thompson JC, Perea E, Wasserman B, Bohannon L, Racioppi A, Choi T, Gasparetto C, Horwitz ME, Long G, Lopez R, Rizzieri DA, Sarantopoulos S, Sullivan KM, Chao NJ, Sung AD. Clinical and Neuroimaging Correlates of Post-Transplant Delirium. Biol Blood Marrow Transplant 2020; 26:2323-2328. [PMID: 32961373 DOI: 10.1016/j.bbmt.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/14/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
Delirium is common among adults undergoing hematopoietic stem cell transplantation (HCT), although the clinical and neuroimaging correlates of post-HCT delirium have not been adequately delineated. We therefore examined the frequency of delirium and neuroimaging correlates of post-transplant delirium in a retrospective cohort of 115 adults undergoing neuroimaging after allogeneic HCT. Delirium was established using previously validated methods for retrospective identification of chart-assessed postprocedural delirium. Chart reviews were independently conducted by a multidisciplinary team with expertise in HCT, psychiatry, and psychology on consecutive allogeneic HCT patients who underwent neuroimaging assessments and transplantation at a single center between January 2009 and December 2016. Neuroimaging markers of white matter damage and brain volume loss were also recorded. In total, 115 patients were included, ranging in age from 20 to 74 years (mean [SD] age, 49 [13]). Fifty-three patients (46%) developed post-HCT delirium. In an adjusted model, delirium incidence was associated with older age (odds ratio [OR], 1.92 [1.28, 2.87] per decade, P = .002), greater severity of white matter hyperintensities (OR, 1.95 [1.06, 3.57], P = .031), and conditioning intensity (OR, 6.37 [2.20, 18.45], P < .001) but was unrelated to cortical atrophy (P = .777). Delirium was associated with fewer hospital-free days (P = .023) but was not associated with overall survival (hazard ratio, 0.95 [0.56, 1.61], P = .844). Greater incidence of delirium following HCT was associated with greater age, microvascular burden, and conditioning intensity. Pre-HCT consideration of microvascular burden and other neuroimaging biomarkers of risk may be warranted.
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Affiliation(s)
- Patrick Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
| | - Jillian C Thompson
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Elena Perea
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Brian Wasserman
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Lauren Bohannon
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Alessandro Racioppi
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Taewoong Choi
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Gwynn Long
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Richard Lopez
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - David A Rizzieri
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Keith M Sullivan
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Nelson J Chao
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
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37
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Hourigan CS, Dillon LW, Gui G, Logan BR, Fei M, Ghannam J, Li Y, Licon A, Alyea EP, Bashey A, Deeg HJ, Devine SM, Fernandez HF, Giralt S, Hamadani M, Howard A, Maziarz RT, Porter DL, Scott BL, Warlick ED, Pasquini MC, Horwitz ME. Impact of Conditioning Intensity of Allogeneic Transplantation for Acute Myeloid Leukemia With Genomic Evidence of Residual Disease. J Clin Oncol 2020; 38:1273-1283. [PMID: 31860405 PMCID: PMC7164487 DOI: 10.1200/jco.19.03011] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Patients with acute myeloid leukemia (AML) in remission remain at risk for relapse even after allogeneic hematopoietic cell transplantation (alloHCT). AML measurable residual disease (MRD) status before alloHCT has been shown to be prognostic. Whether modulation of the intensity of the alloHCT conditioning regimen in patients with AML who test positive for MRD can prevent relapse and improve survival is unknown. METHODS Ultra-deep, error-corrected sequencing for 13 commonly mutated genes in AML was performed on preconditioning blood from patients treated in a phase III clinical trial that randomly assigned adult patients with myeloid malignancy in morphologic complete remission to myeloablative conditioning (MAC) or reduced-intensity conditioning (RIC). RESULTS No mutations were detected in 32% of MAC and 37% of RIC recipients; these groups had similar survival (3-year overall survival [OS], 56% v 63%; P = .96). In patients with a detectable mutation (next-generation sequencing [NGS] positive), relapse (3-year cumulative incidence, 19% v 67%; P < .001) and survival (3-year OS, 61% v 43%; P = .02) was significantly different between the MAC and RIC arms, respectively. In multivariable analysis for NGS-positive patients, adjusting for disease risk and donor group, RIC was significantly associated with increased relapse (hazard ratio [HR], 6.38; 95% CI, 3.37 to 12.10; P < .001), decreased relapse-free survival (HR, 2.94; 95% CI, 1.84 to 4.69; P < .001), and decreased OS (HR, 1.97; 95% CI, 1.17 to 3.30; P = .01) compared with MAC. Models of AML MRD also showed benefit for MAC over RIC for those who tested positive. CONCLUSION This study provides evidence that MAC rather than RIC in patients with AML with genomic evidence of MRD before alloHCT can result in improved survival.
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MESH Headings
- Adult
- Aged
- Circulating Tumor DNA/blood
- Circulating Tumor DNA/genetics
- Clinical Trials, Phase III as Topic
- Female
- Hematopoietic Stem Cell Transplantation/methods
- High-Throughput Nucleotide Sequencing
- Humans
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Mutation
- Neoplasm, Residual
- Prognosis
- Randomized Controlled Trials as Topic
- Transplantation Conditioning/methods
- Transplantation, Homologous
- Young Adult
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Affiliation(s)
| | - Laura W. Dillon
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Gege Gui
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Jack Ghannam
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Yuesheng Li
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | | | - Steven M. Devine
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alan Howard
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Richard T. Maziarz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
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38
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Smith PJ, Lew M, Lowder YP, Romero K, Thompson J, Bohannen L, Pittman A, Sullivan K, Choi T, Gasparetto C, Horwitz ME, Long GD, Lopez R, Rizzieri DA, Sarantopoulos S, Chao NJ, Sung AD. Cognitive Impairment in Candidates for Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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39
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Ramalingam S, Siamakpour-Reihani S, Bohannon L, Ren Y, Sibley A, Nixon A, Lyu J, Xie J, Choi T, Gasparetto C, Horwitz ME, Long GD, Lopez R, Rizzieri DA, Sarantopoulos S, Chao NJ, Sung AD. Phase II Trial of Pasireotide to Prevent GI Toxicity and Acute Gvhd in Allogeneic HSCT. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Islam P, Horwitz ME. Small-molecule nicotinamide for ex vivo expansion of umbilical cord blood. Exp Hematol 2019; 80:11-15. [PMID: 31786243 DOI: 10.1016/j.exphem.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/09/2019] [Accepted: 11/23/2019] [Indexed: 11/17/2022]
Abstract
Umbilical cord blood transplant is an alternative graft source for patients lacking a human leukocyte antigen-matched donor; however, delayed engraftment times have historically resulted in transplant-related morbidity and mortality from complications such as infections and ineffective hematopoiesis. Recent advances in ex vivo expansion techniques have successfully augmented the initial cell dose delivered from an umbilical cord blood graft, leading to improved immune reconstitution, durable hematopoiesis, decreased transplant-related morbidity and mortality, and better outcomes. Herein we review the data for existing and developing ex vivo expansion techniques, with a focus on the preclinical and clinical data for nicotinamide-mediated cord blood expansion across both malignant and benign hematologic indications.
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Affiliation(s)
- Prioty Islam
- Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC.
| | - Mitchell E Horwitz
- Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC
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41
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Saullo JL, Li Y, Messina JA, Thompson J, Dalton T, Giri VK, Reed SD, Miller R, Horwitz ME, Alexander BD, Sung AD. Cytomegalovirus in Allogeneic Hematopoietic Transplantation: Impact on Costs and Clinical Outcomes Using a Preemptive Strategy. Biol Blood Marrow Transplant 2019; 26:568-580. [PMID: 31712193 DOI: 10.1016/j.bbmt.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 12/27/2022]
Abstract
Cytomegalovirus (CMV) results in significant morbidity and mortality following hematopoietic cell transplantation (HCT). Establishing the cost and clinical impact is imperative to the selection of appropriate CMV preventative strategies. This is a retrospective cohort study of consecutive patients undergoing their first allogeneic HCT between January 1, 2009, and December 31, 2013. Detailed clinical and institutional cost data were obtained from the start of conditioning through 1-year post-transplantation. Baseline characteristics, resource utilization, costs, and outcomes were compared between patients with and without clinically significant CMV infection (csCMVi). One hundred seventy out of 388 patients (44%) developed csCMVi within 1 year after HCT. Within the first year post-HCT, patients with csCMVi had a significantly longer transplantation-related length of stay (mean, 91.7 days versus 78.3 days; P < .0001) and more frequent and prolonged hospitalizations (mean, 2.4 versus 1.7 admissions [P < .0001]; mean, 39.1 versus 31.5 inpatient days [P = .001]) without significantly more admissions to the intensive care unit (28.2% versus 21.6%; P = .408). The use of granulocyte colony-stimulating factor was greater in patients with csCMVi (73.5% versus 54.1%; P = .0001), although no significant differences were demonstrated in mean platelet or red blood cell (RBC) transfusions. Total costs were also higher in patients with csCMVi (mean cost difference, $45,811; 95% CI, $26,385 to $67,544). However, the incidence of graft-versus-host disease (GVHD) and selected infectious complications was not significantly different between the 2 groups. There were no significant differences in 1-year and 5-year post-transplantation overall survival (OS) or nonrelapse mortality (NRM) between those with and those without csCMVi, although relapse of underlying disease was significantly lower in the csCMVi group. Overall, our data show that allogeneic HCT recipients with csCMVi had significantly greater medical resource utilization and costs than those without csCMVi. However, clinical outcomes, including GVHD, infections, and mortality, were similar in the 2 groups. Further study is needed to determine the cost-effectiveness of CMV preventive modalities.
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Affiliation(s)
- Jennifer L Saullo
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Yanhong Li
- Duke Clinical Research Institute, Durham, North Carolina
| | - Julia A Messina
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jillian Thompson
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Tara Dalton
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Vinay K Giri
- Duke University School of Medicine, Durham, North Carolina
| | - Shelby D Reed
- Departments of Medicine and Population Health Sciences, Duke University Medical Center, Durham, North Carolina
| | - Rachel Miller
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Barbara D Alexander
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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Cardones AR, Sullivan KM, Green C, Chao NJ, Rowe-Nichols K, Bañez LL, Burton CS, Horwitz ME, Long GD, Rao CL, Sarantopoulos S, Sidhu-Malik N, Sung AD, Hall RP. Interrater Reliability of Clinical Grading Measures for Cutaneous Chronic Graft-vs-Host Disease. JAMA Dermatol 2019; 155:833-837. [PMID: 30994873 PMCID: PMC6583829 DOI: 10.1001/jamadermatol.2018.5459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Cutaneous chronic graft-vs-host disease (cGVHD) is common after allogeneic hematopoietic stem cell transplant and is often associated with poor patient outcomes. A reliable and practical method for assessing disease severity and response to therapy among these patients is urgently needed. Objective To evaluate the interrater agreement and reliability of skin-specific and range of motion (ROM) variables of the 2014 National Institutes of Health (NIH) response criteria for cGVHD and a skin sclerosis grading scale (SSG). Design, Setting, and Participants In this observational study performed at a single tertiary academic center, 6 academic blood and marrow transplant specialists and 4 medical dermatologists examined 8 patients with diagnosed cutaneous cGVHD on July 10, 2015. The patient cohort was enriched for patients with sclerotic features. Each patient was evaluated by using the skin-specific and ROM criteria of the 2014 NIH response criteria for cGVHD and an SSG ranging from 0 to 3. Each patient was also asked to complete quality-of-life scoring instruments. Interrater agreement and reliability were estimated by calculating the Krippendorff α and Cohen κ statistics. Data were analyzed from September 29, 2015, through November 22, 2018. Main Outcomes and Measures Estimation of interrater agreement by interclass coefficient (Krippendorff α and Cohen κ statistics) for the skin-specific and ROM components of the 2014 NIH Response Criteria for Chronic GVHD and for the SSG. Results The median age of the patients evaluated was 54 years (range, 46-58 years). Patients were predominantly male (6 [75%]). Six of the 8 patients had a predominantly sclerotic cutaneous phenotype. Interrater agreement among our experts was acceptable for NIH skin feature score (0.68; 95% CI, 0.30-0.86) and good for NIH ROM scoring (0.80; 95% CI, 0.68-0.86). Dermatologists had acceptable agreement for NIH skin GVHD score (0.69; 95% CI, 0.25-0.82) and skin feature score (0.78; 95% CI, 0.17-0.98), good agreement in ROM grading (0.85; 95% CI, 0.69-0.90), and near perfect agreement in identifying sclerosis (0.82; 95% CI, 0.27-0.97). Conclusions and Relevance Although dermatologists had acceptable agreement in NIH skin GVHD score and skin features score, near perfect agreement in identifying cutaneous sclerosis, better agreement in grading severity of cutaneous cGVHD, especially in the intermediate grades, appears to be needed.
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Affiliation(s)
- Adela R Cardones
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Dermatology, Duke University, Durham, North Carolina.,Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Keith M Sullivan
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Cindy Green
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Krista Rowe-Nichols
- Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Lionel L Bañez
- Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Claude S Burton
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Mitchell E Horwitz
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Gwynn D Long
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Caroline L Rao
- Department of Dermatology, Duke University, Durham, North Carolina.,Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | | | - Anthony D Sung
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Russell P Hall
- Department of Dermatology, Duke University, Durham, North Carolina
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43
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Horwitz ME. Intestinal Acute Graft-versus-Host Disease: A Bug Highway to the Bloodstream. Biol Blood Marrow Transplant 2019; 25:e250-e251. [PMID: 31228585 DOI: 10.1016/j.bbmt.2019.06.011] [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: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Mitchell E Horwitz
- Duke University School of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Durham, NC, USA.
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44
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Lowder YP, Moyers M, Seckar J, Gorecki E, Oldham K, Frutchey J, Beasley K, Guy A, Proch C, Lightbourne T, Verne SD, Stockmann K, Horwitz ME, Chao NJ, Sung AD. Nutrition Practices in Hematopoietic Stem Cell Transplantation (HSCT): A Comparison between Guidelines and Clinical Practice. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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de Koning C, Horwitz ME, Sanz G, Jagasia M, Wagner JE, Stiff PJ, Hanna R, Cilloni D, Nierkens S, Boelens JJ. Rapid and Robust CD4+ and CD8+ T-, NK-, B-Cell, Dendritic Cell, and Monocyte Reconstitution after Nicotinamide-Expanded Cord Blood Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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46
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Maung KK, Chen BJ, Rizzieri DA, Gasparetto C, Sullivan K, Long GD, Engemann AM, Waters-Pick B, Nichols KR, Lopez R, Kang Y, Sarantopoulos S, Sung AD, Chao NJ, Horwitz ME. Phase I, Dose Escalation Study of Naïve T-Cell Depleted Donor Lymphocyte Infusion Following Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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47
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Horwitz ME, Wease S, Blackwell B, Valcarcel D, Frassoni F, Boelens JJ, Nierkens S, Jagasia M, Wagner JE, Kuball J, Koh LP, Majhail NS, Stiff PJ, Hanna R, Hwang WYK, Kurtzberg J, Cilloni D, Freedman LS, Montesinos P, Sanz G. Phase I/II Study of Stem-Cell Transplantation Using a Single Cord Blood Unit Expanded Ex Vivo With Nicotinamide. J Clin Oncol 2018; 37:367-374. [PMID: 30523748 PMCID: PMC6368416 DOI: 10.1200/jco.18.00053] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Increasing the number of hematopoietic stem and progenitor cells within an umbilical cord blood (UCB) graft shortens the time to hematopoietic recovery after UCB transplantation. In this study, we assessed the safety and efficacy of a UCB graft that was expanded ex vivo in the presence of nicotinamide and transplanted after myeloablative conditioning as a stand-alone hematopoietic stem-cell graft. METHODS Thirty-six patients with hematologic malignancies underwent transplantation at 11 sites. RESULTS The cumulative incidence of neutrophil engraftment at day 42 was 94%. Two patients experienced secondary graft failure attributable to viral infections. Hematopoietic recovery was compared with that observed in recipients of standard UCB transplantation as reported to the Center for International Blood and Marrow Transplant Research (n = 146). The median time to neutrophil recovery was 11.5 days (95% CI, 9 to 14 days) for recipients of nicotinamide-expanded UCB and 21 days (95% CI, 20 to 23 days) for the comparator ( P < .001). The median time to platelet recovery was 34 days (95% CI, 32 to 42 days) and 46 days (95% CI, 42 to 50 days) for the expanded and the comparator cohorts, respectively ( P < .001). The cumulative incidence of grade 2 to 4 acute graft-versus-host disease (GVHD) at day 100 was 44%, and grade 3 and 4 acute GVHD at day 100 was 11%. The cumulative incidence at 2 years of all chronic GVHD was 40%, and moderate/severe chronic GVHD was 10%. The 2-year cumulative incidences of nonrelapse mortality and relapse were 24% and 33%, respectively. The 2-year probabilities of overall and disease-free survival were 51% and 43%, respectively. CONCLUSION UCB expanded ex vivo with nicotinamide shortens median neutrophil recovery by 9.5 days (95% CI, 7 to 12 days) and median platelet recovery by 12 days (95% CI, 3 to 16.5 days). This trial establishes feasibility, safety, and efficacy of an ex vivo expanded UCB unit as a stand-alone graft.
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Affiliation(s)
| | | | | | | | | | | | - Stefan Nierkens
- 5 University Medical Center Utrecht, Utrecht, the Netherlands
| | - Madan Jagasia
- 6 Vanderbilt University Medical Center, Nashville, TN
| | | | - Jurgen Kuball
- 5 University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | - Pau Montesinos
- 14 Hospital Universitario y Politécnic de La Fe, Valencia, Spain
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Micallef IN, Stiff PJ, Nademanee AP, Maziarz RT, Horwitz ME, Stadtmauer EA, Kaufman JL, McCarty JM, Vargo R, Cheverton PD, Struijs M, Bolwell B, DiPersio JF. Plerixafor Plus Granulocyte Colony-Stimulating Factor for Patients with Non-Hodgkin Lymphoma and Multiple Myeloma: Long-Term Follow-Up Report. Biol Blood Marrow Transplant 2018; 24:1187-1195. [PMID: 29410180 DOI: 10.1016/j.bbmt.2018.01.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/26/2018] [Indexed: 12/22/2022]
Abstract
The purpose of this report is to analyze long-term clinical outcomes of patients exposed to plerixafor plus granulocyte colony-stimulating factor (G-CSF) for stem cell mobilization. This was a study of patients with non-Hodgkin lymphoma (NHL; n = 167) and multiple myeloma (MM; n = 163) who were enrolled in the long-term follow-up of 2 pivotal phase III studies (NCT00741325 and NCT00741780) of 240 µg/kg plerixafor plus 10 µg/kg G-CSF, or placebo plus 10 µg/kg G-CSF to mobilize and collect CD34+ cells for autologous hematopoietic stem cell transplantation. Overall survival (OS) and progression-free survival (PFS) were evaluated over a 5-year period following the first dose of plerixafor or placebo. The probability of OS was not significantly different in patients with NHL or MM treated with plerixafor or placebo (NHL: 64%; 95% confidence interval [CI], 56% to 71% versus 56%; 95% CI, 44% to 67%, respectively; MM: 64%; 95% CI, 54% to 72% versus 64%; 95% CI, 53% to 73%, respectively). In addition, there was no statistically significant difference in the probability of PFS over 5 years between treatment groups in patients with NHL (50%; 95% CI, 44% to 67% for plerixafor versus 43%; 95% CI, 31% to 54% for placebo) or those with MM (17%; 95% CI, 10% to 24% for plerixafor versus 30%; 95% CI, 21% to 40% for placebo). In this long-term follow-up study, the addition of plerixafor to G-CSF for stem cell mobilization did not affect 5-year survival in patients with NHL or patients with MM.
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Affiliation(s)
| | - Patrick J Stiff
- Division of Hematology/Oncology, Loyola University, Chicago, Illinois
| | | | - Richard T Maziarz
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, North Carolina
| | - Edward A Stadtmauer
- Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan L Kaufman
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - John M McCarty
- Department of Internal Medicine, Virginia Commonwealth University Massey Cancer Center, Richmond, Virginia
| | | | | | | | - Brian Bolwell
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - John F DiPersio
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.
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Sivaraj D, Bacon W, Long GD, Rizzieri DA, Horwitz ME, Sullivan KM, Kang Y, Li Z, Chao NJ, Gasparetto C. High-dose BCNU/Melphalan conditioning regimen before autologous stem cell transplantation in newly diagnosed multiple myeloma. Bone Marrow Transplant 2017; 53:34-38. [DOI: 10.1038/bmt.2017.208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/08/2017] [Accepted: 08/16/2017] [Indexed: 01/31/2023]
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Soiffer RJ, Kim HT, McGuirk J, Horwitz ME, Johnston L, Patnaik MM, Rybka W, Artz A, Porter DL, Shea TC, Boyer MW, Maziarz RT, Shaughnessy PJ, Gergis U, Safah H, Reshef R, DiPersio JF, Stiff PJ, Vusirikala M, Szer J, Holter J, Levine JD, Martin PJ, Pidala JA, Lewis ID, Ho VT, Alyea EP, Ritz J, Glavin F, Westervelt P, Jagasia MH, Chen YB. Prospective, Randomized, Double-Blind, Phase III Clinical Trial of Anti-T-Lymphocyte Globulin to Assess Impact on Chronic Graft-Versus-Host Disease-Free Survival in Patients Undergoing HLA-Matched Unrelated Myeloablative Hematopoietic Cell Transplantation. J Clin Oncol 2017; 35:4003-4011. [PMID: 29040031 DOI: 10.1200/jco.2017.75.8177] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Several open-label randomized studies have suggested that in vivo T-cell depletion with anti-T-lymphocyte globulin (ATLG; formerly antithymocyte globulin-Fresenius) reduces chronic graft-versus-host disease (cGVHD) without compromising survival. We report a prospective, double-blind phase III trial to investigate the effect of ATLG (Neovii Biotech, Lexington, MA) on cGVHD-free survival. Patients and Methods Two hundred fifty-four patients 18 to 65 years of age with acute leukemia or myelodysplastic syndrome who underwent myeloablative HLA-matched unrelated hematopoietic cell transplantation (HCT) were randomly assigned one to one to placebo (n =128 placebo) or ATLG (n = 126) treatment at 27 sites. Patients received either ATLG or placebo 20 mg/kg per day on days -3, -2, -1 in addition to tacrolimus and methotrexate as GVHD prophylaxis. The primary study end point was moderate-severe cGVHD-free survival. Results Despite a reduction in grade 2 to 4 acute GVHD (23% v 40%; P = .004) and moderate-severe cGVHD (12% v 33%; P < .001) in ATLG recipients, no difference in moderate-severe cGVHD-free survival between ATLG and placebo was found (2-year estimate: 48% v 44%, respectively; P = .47). Both progression-free survival (PFS) and overall survival (OS) were lower with ATLG (2-year estimate: 47% v 65% [ P = .04] and 59% v 74% [ P = .034], respectively). Multivariable analysis confirmed that ATLG was associated with inferior PFS (hazard ratio, 1.55; 95% CI, 1.05 to 2.28; P = .026) and OS (hazard ratio, 1.74; 95% CI, 1.12 to 2.71; P = .01). Conclusion In this prospective, randomized, double-blind trial of ATLG in unrelated myeloablative HCT, the incorporation of ATLG did not improve moderate-severe cGVHD-free survival. Moderate-severe cGVHD was significantly lower with ATLG, but PFS and OS also were lower. Additional analyses are needed to understand the appropriate role for ATLG in HCT.
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Affiliation(s)
- Robert J Soiffer
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Haesook T Kim
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph McGuirk
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Mitchell E Horwitz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Laura Johnston
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Mrinal M Patnaik
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Witold Rybka
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew Artz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - David L Porter
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas C Shea
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Michael W Boyer
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Richard T Maziarz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Paul J Shaughnessy
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Usama Gergis
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Hana Safah
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Ran Reshef
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - John F DiPersio
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Patrick J Stiff
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Madhuri Vusirikala
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Jeff Szer
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer Holter
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - James D Levine
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Paul J Martin
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph A Pidala
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Ian D Lewis
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Vincent T Ho
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Edwin P Alyea
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Jerome Ritz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Frank Glavin
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Peter Westervelt
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Madan H Jagasia
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Yi-Bin Chen
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
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