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Borst AJ, Eng W, Griffin M, Ricci KW, Engel E, Adams DM, Dayneka J, Cohen-Cutler SJ, Andreoli SM, Wu MD, Wheeler AP, Heym KM, Crary SE, Nakano TA, Schulte RR, Setty BA, McLean TW, Pahl KS, Intzes S, Pateva I, Teitelbaum M, Zong Z, Li Y, Jeng MR. Treatment practices and response in kaposiform hemangioendothelioma: A multicenter cohort study. Pediatr Blood Cancer 2024; 71:e30779. [PMID: 38073018 DOI: 10.1002/pbc.30779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) are rare vascular tumors in children historically associated with significant morbidity and mortality. This study was conducted to determine first-line therapy in the absence of available prospective clinical trials. METHODS Patients from 17 institutions diagnosed with KHE/TA between 2005 and 2020 with more than 6 months of follow-up were included. Response rates to sirolimus and vincristine were compared at 3 and 6 months. Durability of response and response to other treatment modalities were also evaluated. RESULTS Of 159 unique KHE/TA subjects, Kasabach-Merritt phenomenon (KMP) was present in 64 (40.3%), and only two patients were deceased (1.3%). Over 60% (n = 96) demonstrated treatment response at 3 months, and more than 70% (n = 114) by 6 months (no significant difference across groups). The vincristine group had higher radiologic response at 3 months compared to sirolimus (72.7% vs. 20%, p = .03), but there were no differences between these groups at 6 months. There were no differences in rates of recurrent or progressive disease between vincristine and sirolimus. CONCLUSIONS In this large, multicenter cohort of 159 patients with KHE/TA, rates of KMP were consistent with historical literature, but the mortality rate (1.3%) was much lower. Overall treatment response rates were high (>70%), and there was no significant difference in treatment response or durability of disease comparing sirolimus to vincristine. Our results support individualized treatment decision plans depending on clinical scenario and patient/physician preferences. Response criteria and response rates reported here will be useful for guiding future treatment protocols for vascular tumors.
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Affiliation(s)
- Alexandra J Borst
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Whitney Eng
- Harvard Medical School/Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Morgan Griffin
- Harvard Medical School/Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Kiersten W Ricci
- The University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Elissa Engel
- The University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Denise M Adams
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jillian Dayneka
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Tulane School of Medicine/Children's Hospital New Orleans, New Orleans, Louisiana, USA
| | - Sally J Cohen-Cutler
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Keck School of Medicine of University of Southern California/Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Steven M Andreoli
- University of Florida College of Medicine-Jacksonville/Nemours Children's Specialty Care, Jacksonville, Florida, USA
| | - Melinda D Wu
- Oregon Health & Science University, Doernbecher Children's Hospital, Portland, Oregon, USA
| | - Allison P Wheeler
- Vanderbilt University School of Medicine/Monroe Carell Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Shelley E Crary
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Taizo A Nakano
- University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rachael R Schulte
- Indiana University School of Medicine/Riley Children's Hospital, Indianapolis, Indiana, USA
| | - Bhuvana A Setty
- Ohio State University College of Medicine/Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Thomas W McLean
- Wake Forest University School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Kristy S Pahl
- Duke University School of Medicine, Duke Children's Hospital, Durham, North Carolina, USA
| | - Stefanos Intzes
- Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington, USA
| | - Irina Pateva
- Case Western Reserve University/Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | | | - Zili Zong
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yimei Li
- Perelman School of Medicine at the University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael R Jeng
- Stanford University School of Medicine/Lucile Packard Children's Hospital, Palo Alto, California, USA
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Alali M, Balsara K, Khaitan A, Streicher DA, Barros KL, Budnick HC, Schulte RR. Successful isavuconazole salvage therapy for cerebral mucormycosis in a child with relapsed leukemia: A light in the dark tunnel. Pediatr Blood Cancer 2023; 70:e29807. [PMID: 35657144 DOI: 10.1002/pbc.29807] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Muayad Alali
- Department of Pediatrics, Ryan White Center for Pediatric, Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Karl Balsara
- Department of Neurosurgery, Goodman Campbell Brain and Spine, Riley Hospital for Children, Section of Pediatric Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alka Khaitan
- Department of Pediatrics, Ryan White Center for Pediatric, Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Drew A Streicher
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kathryn L Barros
- Department of Pediatrics, Ryan White Center for Pediatric, Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hailey C Budnick
- Department of Neurosurgery, Goodman Campbell Brain and Spine, Riley Hospital for Children, Section of Pediatric Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rachael R Schulte
- Department of Pediatrics, Section of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Schulte RR, Choi L, Utreja N, Van Driest SL, Stein CM, Ho RH. Effect of SLCO1B1 Polymorphisms on High-Dose Methotrexate Clearance in Children and Young Adults With Leukemia and Lymphoblastic Lymphoma. Clin Transl Sci 2021; 14:343-353. [PMID: 32961024 PMCID: PMC7877862 DOI: 10.1111/cts.12879] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 02/04/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023] Open
Abstract
High-dose (HD) methotrexate (MTX) is a critical component of treatment for hematologic malignancies in children and young adults. Therapeutic drug monitoring is necessary due to substantial interindividual variation in MTX clearance. Common function-altering polymorphisms in SLCO1B1 (encodes OATP1B1, which transports MTX) may contribute to clearance variability. We performed pharmacokinetic modeling using data for 106 children and young adults treated with HD MTX for hematologic malignancies; of 396 total courses of HD MTX, 360 consisted of 5 g/m2 over 24 hours. We evaluated the contribution of clinical covariates and SLCO1B1 genotype (388A>G and 521T>C) to MTX clearance variability. Of the clinical covariates studied, patient weight improved the pharmacokinetic model most significantly (P < 0.001). The addition of the SLCO1B1 variants individually further improved the model (P < 0.05 for each). An interaction between these variants was suggested when both were included (P = 0.017). SLCO1B1 genotype should be considered in efforts to personalize HD MTX dosing.
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Affiliation(s)
- Rachael R. Schulte
- Department of PediatricsDivision of Pediatric Hematology/OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA,Present address:
Department of PediatricsDivision of Pediatric Hematology/OncologyRiley Hospital for Children at IU Health and Indiana University School of MedicineIndianapolisIndianaUSA
| | - Leena Choi
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Nipun Utreja
- Department of PediatricsDivision of Pediatric Hematology/OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sara L. Van Driest
- Department of PediatricsDivision of General PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - C. Michael Stein
- Department of MedicineDivision of Clinical PharmacologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Richard H. Ho
- Department of PediatricsDivision of Pediatric Hematology/OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
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Schulte RR, Ho RH. Organic Anion Transporting Polypeptides: Emerging Roles in Cancer Pharmacology. Mol Pharmacol 2019; 95:490-506. [PMID: 30782852 DOI: 10.1124/mol.118.114314] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/09/2019] [Indexed: 12/13/2022] Open
Abstract
The organic anion transporting polypeptides (OATPs) are a superfamily of drug transporters involved in the uptake and disposition of a wide array of structurally divergent endogenous and exogenous substrates, including steroid hormones, bile acids, and commonly used drugs, such as anti-infectives, antihypertensives, and cholesterol lowering agents. In the past decade, OATPs, primarily OATP1A2, OATP1B1, and OATP1B3, have emerged as potential mediators of chemotherapy disposition, including drugs such as methotrexate, doxorubicin, paclitaxel, docetaxel, irinotecan and its important metabolite 7-ethyl-10-hydroxycamptothecin, and certain tyrosine kinase inhibitors. Furthermore, OATP family members are polymorphic and numerous studies have shown OATP variants to have differential uptake, disposition, and/or pharmacokinetics of numerous drug substrates with important implications for interindividual differences in efficacy and toxicity. Additionally, certain OATPs have been found to be overexpressed in a variety of human solid tumors, including breast, liver, colon, pancreatic, and ovarian cancers, suggesting potential roles for OATPs in tumor development and progression and as novel targets for cancer therapy. This review focuses on the emerging roles for selected OATPs in cancer pharmacology, including preclinical and clinical studies suggesting roles in chemotherapy disposition, the pharmacogenetics of OATPs in cancer therapy, and OATP overexpression in various tumor tissues with implications for OATPs as therapeutic targets.
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Affiliation(s)
- Rachael R Schulte
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard H Ho
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
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Schulte RR, Ho RH. Effect of SLCO polymorphisms on high-dose methotrexate clearance in pediatric oncology patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Schulte RR, Madiwale MV, Flower A, Hochberg J, Burke MJ, McNeer JL, DuVall A, Bleyer A. Levocarnitine for asparaginase-induced hepatic injury: a multi-institutional case series and review of the literature. Leuk Lymphoma 2018; 59:2360-2368. [PMID: 29431566 PMCID: PMC10183102 DOI: 10.1080/10428194.2018.1435873] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Asparaginase, an important treatment component for acute lymphoblastic leukemia (ALL), causes severe hepatotoxicity in some patients. Levocarnitine is a mitochondrial co-factor that can potentially ameliorate the mitochondrial toxicity of asparaginase. In this retrospective case series, we describe the clinical presentation and management of six pediatric and young adult patients (mean age 12.7, range 9-24 years) with ALL who developed Grade 3-4 hyperbilirubinemia following administration of asparaginase as part of induction/re-induction therapy. Five of these patients were treated with levocarnitine with subsequent improvement of hyperbilirubinemia, while one patient was given levocarnitine prophylactically during induction and developed Grade 3 hyperbilirubinemia, but did not require therapy adjustments or delays. Increased awareness in the pediatric oncology community regarding asparaginase-associated hepatic toxicity and the potential role of levocarnitine in management is warranted.
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Affiliation(s)
- Rachael R Schulte
- a Department of Pediatrics, Division of Pediatric Hematology/Oncology , Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center , Nashville , TN , USA
| | - Manasi V Madiwale
- b Division of Pediatric Hematology/Oncology , Children's Hospital and Research Center , Oakland , CA , USA
| | - Allyson Flower
- c Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation , New York Medical College , Valhalla , NY , USA
| | - Jessica Hochberg
- c Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation , New York Medical College , Valhalla , NY , USA
| | - Michael J Burke
- d Department of Pediatrics, Division of Hematology/Oncology/Blood and Marrow Transplantation , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Jennifer L McNeer
- e Department of Pediatrics, Section of Pediatric Hematology/Oncology/Stem Cell Transplant , University of Chicago Medical Center , Chicago , IL , USA
| | - Adam DuVall
- f Department of Medicine, Division of Hematology and Medical Oncology, and Department of Pediatrics, Division of Pediatric Hematology/Oncology, OHSU Doernbecher Children's Hospital , Oregon Health and Science University , Portland , OR , USA
| | - Archie Bleyer
- g Department of Radiation Medicine , Oregon Health and Science University , Portland , OR , USA
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Portnoy HD, Schulte RR, Fox JL, Croissant PD, Tripp L. Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematomas. J Neurosurg 1973; 38:729-38. [PMID: 4710652 DOI: 10.3171/jns.1973.38.6.0729] [Citation(s) in RCA: 167] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
✓ An anti-siphoning valve for use in hydrocephalic shunt systems is described. The addition of this valve to the system effectively reduces the hazard of negative intraventricular pressure when the patient is sitting or standing. The formation of post-shunt subdural hematomas was prevented by temporary postoperative occlusion of the shunt using a percutaneously reversible occlusion valve, which is also described.
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