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Bourne G, Diebold K, Espinoza-Gutarra M, Al-Kadhimi Z, Bachiashvili K, Rangaraju S, Vachhani P, Bhatia R, Jamy O. Addition of single dose gemtuzumab ozogamicin to intensive induction chemotherapy in core-binding factor acute myeloid leukemia. Leuk Res 2024; 139:107467. [PMID: 38460432 DOI: 10.1016/j.leukres.2024.107467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/23/2024] [Accepted: 02/24/2024] [Indexed: 03/11/2024]
Abstract
In a meta-analysis of 5 trials, the addition of gemtuzumab ozogamicin (GO) to intensive induction chemotherapy led to a survival benefit in patients with core-binding factor (CBF) acute myeloid leukemia (AML). Given the heterogeneous incorporation of GO in clinical trials, the ideal dose and schedule remains unclear. We conducted a single-center retrospective analysis to compare outcomes of patients with CBF-AML treated with intensive induction chemotherapy, with or without a single dose of GO 3 mg/m2, during induction only. We included 87 patients (GO=32, control=55). The composite complete remission (cCR) rate was higher in the control group (93%) compared to the GO group (82%) (p<0.001). The rate of measurable residual disease (MRD) negative cCR, by flow cytometry, was similar between both groups. There were no significant differences between the two groups in terms of toxicity. The 3-year relapse-free survival (RFS) for both groups was similar (71% vs 68%, p=0.5). The 3-year overall survival (OS) for the GO group was 68%, compared to 66% for the control group (p=0.9).In multivariable analysis, age and MRD positive status were risk factors for inferior outcomes. We find that survival of patients with CBF-AML is favorable in the real-world setting. The addition of single-dose GO, during induction, did not lead to a higher remission rate or survival benefit, when compared to intensive chemotherapy without GO. Further investigation into the incorporation of GO in the treatment algorithm for CBF-AML is needed.
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Affiliation(s)
- Garrett Bourne
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kendall Diebold
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Manuel Espinoza-Gutarra
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zaid Al-Kadhimi
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimo Bachiashvili
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sravanti Rangaraju
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ravi Bhatia
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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2
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Dunn-Valadez S, Bathini S, Purdy KE, Bachiashvili K, Bhatia R, Jamy O, Rangaraju S, Mehta A, Godby K, Goyal G, Worth S, Oliver JD, Mikhail FM, Choi JK, Morlote D, Reddy VB, Vachhani P. Utility of end of induction bone marrow biopsy and survival outcomes in acute promyelocytic leukemia treated with fixed-dose induction regimen. Leuk Lymphoma 2023; 64:1673-1680. [PMID: 37493540 DOI: 10.1080/10428194.2023.2234529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 06/29/2023] [Indexed: 07/27/2023]
Abstract
Significant variations exist related to the end of induction practices in the management of Acute Promyelocytic Leukemia (APL). These variations include all-trans retinoic acid (ATRA)-arsenic trioxide (ATO) in fixed doses versus continuation until hematologic complete remission (CR) and performance versus omission of post-induction bone marrow biopsy to confirm morphological CR. A retrospective chart review was conducted of 61 patients (42 low/intermediate-risk and 19 high-risk) aged ≥ 18 years with newly diagnosed APL treated with fixed duration ATRA-ATO +/- cytoreduction at a tertiary medical center from December 2012 through March 2020. Of the 54 patients with post-induction bone marrow biopsy results, 52 (96%) demonstrated no morphologic evidence of APL while the remaining were equivocal. After 2.6 years median follow-up, no relapses occurred. The estimated 2-year overall survival rate of 95% suggests excellent outcomes with a fixed ATO induction regimen and safe omission of post-induction bone marrow biopsy irrespective of hematologic parameters.
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Affiliation(s)
- Sydney Dunn-Valadez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Srilakshmi Bathini
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathleen E Purdy
- Department of Medical Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimo Bachiashvili
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ravi Bhatia
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Omer Jamy
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sravanti Rangaraju
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amitkumar Mehta
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly Godby
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gaurav Goyal
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Worth
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Josh D Oliver
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fady M Mikhail
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John K Choi
- Division of Anatomic Pathology and Neuropathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Diana Morlote
- Division of Anatomic Pathology and Neuropathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishnu B Reddy
- Division of Anatomic Pathology and Neuropathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankit Vachhani
- Div of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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3
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Jamy O, Diebold K, Davis K, Bachiashvili K, Rangaraju S, Vachhani P, Godby KN, Salzman D, Bhatia R. Impact of induction intensity and transplantation on outcomes of patients with complex karyotype and TP53-mutated acute myeloid leukemia. Bone Marrow Transplant 2023; 58:823-825. [PMID: 37012416 DOI: 10.1038/s41409-023-01977-7] [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: 03/13/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kendall Diebold
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth Davis
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimo Bachiashvili
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sravanti Rangaraju
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly N Godby
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna Salzman
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ravi Bhatia
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Zainaldin C, Arora S, Bathini S, Gupta U, Pandya V, Bae S, Worth S, Bachiashvili K, Bhatia R, Godby K, Jamy O, Rangaraju S, Diamond B, Oliver JD, Salzman D, Di Stasi A, Vachhani P. Dismal survival outcomes of patients with acute myeloid leukemia after failure of venetoclax with hypomethylating agents. Leuk Lymphoma 2022; 63:3245-3248. [PMID: 36107006 DOI: 10.1080/10428194.2022.2113530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Carl Zainaldin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sankalp Arora
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Srilakshmi Bathini
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Udita Gupta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishruti Pandya
- Divison of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Sejong Bae
- Divison of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Sarah Worth
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimo Bachiashvili
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Ravi Bhatia
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Kelly Godby
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Omer Jamy
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Sravanti Rangaraju
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Barry Diamond
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Josh D Oliver
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna Salzman
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Antonio Di Stasi
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
| | - Pankit Vachhani
- Divison of Hematology/Oncology, Dept of Medicine, University of at Birmingham, Birmingham, AL, USA
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Ashraf S, Wolfson J, Vachhani P, Rangaraju S, Bachiashvili K, Bhatia R, Jamy O. Safe and Effective Use of Imatinib to Treat Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia During Pregnancy. J Adolesc Young Adult Oncol 2022; 11:617-620. [PMID: 35049365 DOI: 10.1089/jayao.2021.0200] [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] [Indexed: 12/16/2022] Open
Abstract
Philadelphia chromosome positive (Ph+) B cell acute lymphoblastic leukemia (ALL) is extremely rare in pregnancy. Although the use of tyrosine kinase inhibitors (TKIs) has significantly improved outcomes of patients with Ph+ ALL, its use during pregnancy is not recommended due to the risk of fetal malformations. There are limited data on the use of TKIs during pregnancy and its long-term effects on the fetus. Within this context, we present a case of a 25-year-old woman diagnosed with Ph+ ALL during the third trimester and the safe and effective use of imatinib as treatment after failure of conventional chemotherapy.
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Affiliation(s)
- Sarah Ashraf
- The Aga Khan University-Medical College, Karachi, Pakistan
| | - Julie Wolfson
- Division of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pankit Vachhani
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sravanti Rangaraju
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kimo Bachiashvili
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ravi Bhatia
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Omer Jamy
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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6
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Zainaldin C, Arora S, Bathini S, Pandya V, Bae S, Gupta U, Worth` S, Bachiashvili K, Bhatia R, Godby KN, Jamy O, Rangaraju S, Diamond B, Oliver JD, Salzman DE, Di Stasi A, Vachhani P. Survival outcomes of patients with relapsed or refractory acute myeloid leukemia after venetoclax combined with hypomethylating agents. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18808 Background: Venetoclax in combination with hypomethylating agents (HMA+Ven) is the standard-of-care treatment for patients with newly diagnosed acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy. HMA+Ven is also commonly used as salvage therapy for relapsed or refractory (R/R) AML. There is limited data regarding outcomes of AML patients after HMA+Ven failure. In clinical practice, survival following HMA+Ven failure, either as frontline or salvage therapy, is observed to be poor. Methods: We conducted a single center retrospective study to evaluate survival outcomes of AML patients who were R/R to HMA+Ven as frontline or salvage therapy. Patients ≥ 18 years of age with AML who initiated HMA+Ven between 06/2018 and 05/2021 were included. R/R AML was defined as clinically relevant disease with ≥ 5% blasts after prior complete remission/morphologic leukemia free state, refractoriness to at least two cycles of HMA+Ven, or progressive disease despite initiating HMA+Ven. Data cut-off was 02/07/2022. Overall survival (OS) was estimated using Kaplan-Meier method and outcome differences between sub-groups were assessed using the log rank test. Results: Forty-two patients met inclusion criteria. Baseline characteristics and treatment details are summarized in Table. The median OS of the overall cohort was 2.3 months (range 0.1-11.4). There was no significant difference in median OS between patients declared R/R to frontline vs salvage HMA+Ven (2.4 vs 1.8 months, hazard ratio [HR] = 0.84, 95% confidence interval [CI] 0.43-1.62). Patients who received treatment after HMA+Ven failure had longer median OS compared to patients who did not (n = 17, 4.7 vs 1.7 months, HR = 0.29, 95% CI 0.13-0.62). There was no significant difference in OS based on the sub-type of AML, ELN risk group, p53 mutation, or complex karyotype status. Conclusions: Data from our study support the clinical observation that AML patients with disease R/R to HMA+Ven, either as frontline or salvage therapy, have very poor survival outcomes. These results provide important prognostic information for clinicians and highlight the need for novel therapies for R/R AML.[Table: see text]
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Affiliation(s)
- Carl Zainaldin
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Sankalp Arora
- The University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Sri Bathini
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Vishruti Pandya
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Sejong Bae
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Udita Gupta
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Sarah Worth`
- University of Alabama at Birmingham, Department of Pharmacy, Birmingham, AL
| | - Kimo Bachiashvili
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Ravi Bhatia
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Kelly Nicole Godby
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Omer Jamy
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Sravanti Rangaraju
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Barry Diamond
- University of Alabama at Birmingham, Department of Pharmacy, Birmingham, AL
| | - Josh D Oliver
- University of Alabama at Birmingham, Department of Pharmacy, Birmingham, AL
| | - Donna E. Salzman
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Antonio Di Stasi
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Pankit Vachhani
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
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Vachhani P, Murthy GSG, Jamy O, Bachiashvili K, Rangaraju S, Cole T, Augelli-Szafran CE, Boohaker RJ, Moukha-Chafiq O, Hanks LJ, Stinson K, Jung DY, Atallah EL, Bhatia R. A phase 1 study of NTX-301, an oral DNMT1 inhibitor, in patients with MDS and AML (trial in progress). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps7077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS7077 Background: Patients with relapsed and/or refractory (r/r) myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), and acute myeloid leukemia (AML) who are not candidates for stem-cell transplantation have dismal outcomes. Novel therapies are needed. The nucleoside analogue NTX-301 (5-aza-4’-thio-2’-deoxycytidine or Aza-TdC) is incorporated into DNA, where it engages the active site of DNA methyltransferase I (DNMT1), a maintenance methyltransferase that contributes to the hypermethylation and silencing of tumor suppressor genes. DNMT1 can become trapped in a covalent complex with DNA, thus depleting free enzyme and inhibiting the normal maintenance methylation of CpG sites, resulting in re-activation of tumor suppressor genes. Preclinical data suggest a correlation between NTX-301 activity in leukemia xenograft models and decreased levels of DNMT1. NTX-301 offers an improvement over traditional DNA methyltransferase inhibitors (azacitidine, decitabine) by virtue of a higher incorporation rate into DNA at lower levels of cytotoxicity. Methods: This is a phase 1, open-label, multi-center, dose-escalation study to assess the safety, tolerability, and recommended myeloid monotherapy dose of NTX-301 in patients with r/r myeloid neoplasms. Patients ≥ 18 years with r/r higher-risk MDS (intermediate, high, very-high risk by IPSS-R), high-risk CMML (int-2/high by CPSS or CPSS-mol), or AML (marrow blasts ≤ 30% or WBC < 20,000 cells/µL without leukoreduction) are eligible. Other key eligibility criteria: Eastern Cooperative Oncology Group performance status 0–2; adequate cardiac, renal, and liver function; and resolved acute effects of any prior therapy. Successive cohorts of patients will receive escalating doses of NTX-301 starting from 2 mg QD. Each cycle is 21 days in duration (treatment for 5 days/week x 2 weeks and 1 week off). The trial incorporates accelerated titration design for dose level 1 and 2 followed by traditional 3+3 dose escalation design (3-6 patients per cohort) from dose level 3. Intrapatient dose escalation is allowed. NTX-301 treatment will continue until disease progression or unacceptable toxicity, whichever occurs first. Primary endpoints: incidence and severity of adverse events, dose-limiting toxicities (DLTs), maximum tolerated dose (MTD), biologically effective dose (BED). Secondary endpoints: PK parameters of NTX-301, PD assessment through global hypomethylation assay and other markers in blood and marrow, and clinical efficacy [overall response rate (ORR), complete remission (CR), marrow CR (mCR), partial remission (PR), stable disease (SD), hematologic improvement (HI) per mIWG criteria]. After the MTD/BED is identified, the safety and efficacy of NTX-301 will be explored further in selected myeloid malignancies. The study began enrolling patients in January 2021 and is still recruiting. Clinical trial information: NCT04167917.
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Affiliation(s)
- Pankit Vachhani
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | | | - Omer Jamy
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | | | - Sravanti Rangaraju
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Tonya Cole
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | | | - Ravi Bhatia
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
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Jamy O, Lin K, Worth S, Bachiashvili K, Rangaraju S, Vachhani P, Bhatia R. Hypomethylating agent/venetoclax versus intensive chemotherapy in adults with relapsed or refractory acute myeloid leukaemia. Br J Haematol 2022; 198:e35-e37. [PMID: 35509246 DOI: 10.1111/bjh.18229] [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: 02/22/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Karen Lin
- Department of Medicine, Grandview Medical Center, Birmingham, Alabama, USA
| | - Sarah Worth
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Kimo Bachiashvili
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Sravanti Rangaraju
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Ravi Bhatia
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
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9
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Dunn-Valadez S, Bathini S, Elston C, Rangaraju S, Stasi AD, Worth S, Morlote D, Harada S, Vachhani P. IDH1 inhibitor-induced neutrophilic dermatosis in a patient with acute myeloid leukemia. Cancer Treat Res Commun 2022; 31:100560. [PMID: 35460975 DOI: 10.1016/j.ctarc.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/13/2022] [Accepted: 04/10/2022] [Indexed: 06/14/2023]
Abstract
Ivosidenib is an oral inhibitor of mutant Isocitrate dehydrogenase 1 (IDH1). It is approved for treatment of patients with relapsed or refractory IDH1-mutated acute myeloid leukemia (AML) and patients with newly diagnosed IDH1-mutated AML who are 75 years or older or those who are ineligible to receive intensive chemotherapy. While generally well tolerated, differentiation syndrome has been reported in 15-20% of patients. Here, we report a case of acute febrile neutrophilic dermatosis or Sweet's syndrome in conjunction with the use of ivosidenib for the treatment of relapsed AML. We discuss the clinical presentation of this rare entity, review relevant literature, and comment on its association with differentiation syndrome.
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Affiliation(s)
- Sydney Dunn-Valadez
- Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Srilakshmi Bathini
- Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Carly Elston
- Dept of Dermatology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sravanti Rangaraju
- Div of Hematology/Oncology, Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Antonio Di Stasi
- Div of Hematology/Oncology, Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sarah Worth
- Dept of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Diana Morlote
- Div of Anatomic Pathology and Neuropathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Shuko Harada
- Div of Anatomic Pathology and Neuropathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Pankit Vachhani
- Div of Hematology/Oncology, Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
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10
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Arora S, Zainaldin C, Bathini S, Gupta U, Worth S, Bachiashvili K, Bhatia R, Godby K, Jamy O, Rangaraju S, Diamond B, Oliver JD, Salzman D, Stasi AD, Vachhani P. CLO22-037: Tumor Lysis Syndrome and Infectious Complications During Induction With Venetoclax Combined With Azacitidine or Decitabine in Patients With Acute Myeloid Leukemia. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7292] [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: 11/17/2022]
Affiliation(s)
- Sankalp Arora
- 1 University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Udita Gupta
- 1 University of Alabama at Birmingham, Birmingham, AL
| | - Sarah Worth
- 1 University of Alabama at Birmingham, Birmingham, AL
| | | | - Ravi Bhatia
- 1 University of Alabama at Birmingham, Birmingham, AL
| | - Kelly Godby
- 1 University of Alabama at Birmingham, Birmingham, AL
| | - Omer Jamy
- 1 University of Alabama at Birmingham, Birmingham, AL
| | | | - Barry Diamond
- 1 University of Alabama at Birmingham, Birmingham, AL
| | | | - Donna Salzman
- 1 University of Alabama at Birmingham, Birmingham, AL
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11
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Bal S, Narkhede M, Shea LK, Rangaraju S, Giri S, Vachhani P, Jamy O, Godby K, Goyal G, Ravi G, Bachiashvili K, Di Stasi A, Bhatia R, Salzman D, Mehta A, Costa LJ. Chimeric Antigen Receptor T Cells Mediated Toxicities Are Associated with Hyponatremia. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brown PA, Shah B, Advani A, Aoun P, Boyer MW, Burke PW, DeAngelo DJ, Dinner S, Fathi AT, Gauthier J, Jain N, Kirby S, Liedtke M, Litzow M, Logan A, Luger S, Maness LJ, Massaro S, Mattison RJ, May W, Oluwole O, Park J, Przespolewski A, Rangaraju S, Rubnitz JE, Uy GL, Vusirikala M, Wieduwilt M, Lynn B, Berardi RA, Freedman-Cass DA, Campbell M. Acute Lymphoblastic Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:1079-1109. [PMID: 34551384 DOI: 10.6004/jnccn.2021.0042] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Acute Lymphoblastic Leukemia (ALL) focus on the classification of ALL subtypes based on immunophenotype and cytogenetic/molecular markers; risk assessment and stratification for risk-adapted therapy; treatment strategies for Philadelphia chromosome (Ph)-positive and Ph-negative ALL for both adolescent and young adult and adult patients; and supportive care considerations. Given the complexity of ALL treatment regimens and the required supportive care measures, the NCCN ALL Panel recommends that patients be treated at a specialized cancer center with expertise in the management of ALL This portion of the Guidelines focuses on the management of Ph-positive and Ph-negative ALL in adolescents and young adults, and management in relapsed settings.
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Affiliation(s)
- Patrick A Brown
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Anjali Advani
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Jordan Gauthier
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Nitin Jain
- The University of Texas MD Anderson Cancer Center
| | | | | | | | - Aaron Logan
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Selina Luger
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | - Jae Park
- Memorial Sloan Kettering Cancer Center
| | | | | | - Jeffrey E Rubnitz
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Geoffrey L Uy
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Beth Lynn
- National Comprehensive Cancer Network
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13
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Jadhav AP, Desai SM, Panczykowski DM, Rangaraju S, Campbell D, Ritvonen JK, Schreiner M, Silvennoinen H, Gerber J, Puetz V, Raza SA, Haussen DC, Nogueira RG, Strbian D, Jovin TG, Lindsberg PJ. Predicting outcomes after acute reperfusion therapy for basilar artery occlusion. Eur J Neurol 2020; 27:2176-2184. [PMID: 32558040 DOI: 10.1111/ene.14406] [Citation(s) in RCA: 8] [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: 05/08/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Basilar artery occlusion (BAO) leads to high rates of morbidity and mortality, despite successful recanalization. The discordance between flow restoration and long-term functional status clouds clinical decision-making regarding further aggressive care. We sought to develop and validate a practical, prognostic tool for the prediction of 3-month favorable outcome after acute reperfusion therapy for BAO. METHODS This retrospective, multicenter, observational study was conducted at four high-volume stroke centers in the USA and Europe. Multivariate regression analysis was performed to identify predictors of favorable outcome (90-day modified Rankin scale scores 0-2) and derive a clinically applicable prognostic model (the Pittsburgh Outcomes after Stroke Thrombectomy-Vertebrobasilar (POST-VB) score). The POST-VB score was evaluated and internally validated with regard to calibration and discriminatory ability. External validity was assessed in patient cohorts at three separate centers. RESULTS In the derivation cohort of 59 patients, independent predictors of favorable outcome included smaller brainstem infarct volume on post-procedure magnetic resonance imaging (P < 0.01) and younger age (P = 0.01). POST-VB score was calculated as: age + (10 × brainstem infarct volume). POST-VB score demonstrated excellent discriminatory ability [area under the receiver-operating characteristic curve (AUC) = 0.91] and adequate calibration (P = 0.88) in the derivation cohort (Center A). It performed equally well across the three external validation cohorts (Center B, AUC = 0.89; Center C, AUC = 0.78; Center D, AUC = 0.80). Overall, a POST-VB score < 49 was associated with an 88% likelihood of favorable outcome, as compared to 4% with a score ≥ 125. CONCLUSIONS The POST-VB score effectively predicts 3-month functional outcome following acute reperfusion therapy for BAO and may aid in guiding post-procedural care.
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Affiliation(s)
- A P Jadhav
- Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - S M Desai
- Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - D M Panczykowski
- Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Rangaraju
- Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - D Campbell
- Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - J K Ritvonen
- Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
| | - M Schreiner
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Department of Neurology, Dresden, Germany
| | - H Silvennoinen
- Helsinki Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - J Gerber
- Institute of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - V Puetz
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Department of Neurology, Dresden Neurovascular Center, Dresden, Germany
| | - S A Raza
- Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - D C Haussen
- Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - R G Nogueira
- Department of Neurology, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - D Strbian
- Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - T G Jovin
- Department of Neurology, Cooper University Hospital, Camden, NJ, USA
| | - P J Lindsberg
- Neurological Research Unit, Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, University of Helsinki, Helsinki, Finland
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14
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Al-Issa K, Rangaraju S, Al-Hader AA. Student loan debt and visa status influence on career choices for hematology and medical oncology fellows in the United States. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11024 Background: There are multiple factors influencing future career plans for US hematology/oncology fellows. The objective of this study is to evaluate the effects of student loan debt and visa status as potential factors affecting their career choices. Methods: A total of 159 US hematology/oncology fellowship programs were contacted, program directors forwarded the survey to current hematology/oncology fellows and recent graduates (classes of 2019, 2018 and 2017). The survey consisted of 13 questions regarding their student loan debt and visa status, research experience, initial career plan, current career for graduates, the influence of student loan debt and visa status on their career decisions (academic, private practice, industry), and whether or not their training programs had resources or mentorship to help them deal with those factors. We used a scale of 1-5 to determine how much each factor affected career choice (1 = extremely unaffected, 5 = extremely affected). Results: A total of 220 physicians have participated, 177 (80.5%) fellows and 43 (19.5%) graduates. For graduates, 35% had student loans during fellowship, 40% of them thought that their loans affected their career choice with a score of 4-5. 93% of graduates with student loans answered that they weren't aware of resources/mentorship to address their loans effect on their career. 44% of graduates were on J1/H1 visa during training, 74% of them thought that their visa status affected their career choice with score of 4-5. 63% of graduates who were on visa answered that they weren't aware of resources/mentorship to address visa status as a factor influencing their career options. For current fellows, 51% have student loans, one third of them thought that their loans affected their career choice with score 4-5. 77% of fellows with student loans answered that they weren't aware of resources/mentorship to address their loans effect on their career. 16% of current fellows are on J1/H1 visa, 66% of them thought that their visa status is affecting their career choice with score 4-5. 62% of fellows who are on visa answered that they weren't aware of resources/mentorship to address visa status as a factor influencing their career options. Conclusions: Hematology/oncology fellows report that student loan debt and visa status are important factors affecting their career decisions. The majority of hematology/oncology fellows in this survey weren’t aware of resources or mentorship to help deal with these factors. Mentors need to be aware of these factors to help fellows achieve their career goals.
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Affiliation(s)
- Karam Al-Issa
- Indiana University School of Medicine, Indianapolis, IN
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15
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Streib CD, Rangaraju S, Campbell DT, Winger DG, Paolini SL, Zhang AJ, Jankowitz BT, Jadhav AP, Jovin TG. Infarct Volume Predicts Hospitalization Costs in Anterior Circulation Large-Vessel Occlusion Stroke. AJNR Am J Neuroradiol 2018; 40:51-58. [PMID: 30591512 DOI: 10.3174/ajnr.a5917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/21/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Anterior circulation large-vessel occlusion stroke, one of the most devastating stroke subtypes, is associated with substantial economic burden. We aimed to identify predictors of increased acute care hospitalization costs associated with anterior circulation large-vessel occlusion stroke. MATERIALS AND METHODS Comprehensive cost-tracking software was used to calculate acute care hospitalization costs for patients with anterior circulation large-vessel occlusion stroke admitted July 2012 to October 2014. Patient demographics and stroke characteristics were analyzed, including final infarct volume on follow-up neuroimaging. Predictors of hospitalization costs were determined using multivariable linear regression including subgroup cost analyses by treatment technique (endovascular, IV tPA-only, and no reperfusion therapy) and sensitivity analyses incorporating patients initially excluded due to early withdrawal of care. RESULTS Three hundred forty-one patients (median age, 69 years; interquartile range, 57-80 years; median NIHSS score, 16; interquartile range, 13-21) were included in our primary analysis. Final infarct volume, parenchymal hematoma, baseline NIHSS score, ipsilateral carotid stenosis, age, and obstructive sleep apnea were significant predictors of acute care hospitalization costs. Final infarct volume alone accounted for 20.87% of the total cost variance. Additionally, final infarct volume was consistently the strongest predictor of increased cost in primary, subgroup, and sensitivity analyses. CONCLUSIONS Final infarct volume was the strongest predictor of increased hospitalization costs in anterior circulation large-vessel occlusion stroke. Acute stroke therapies that reduce final infarct volume may not only improve clinical outcomes but may also prove cost-effective.
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Affiliation(s)
- C D Streib
- From the Department of Neurology (C.D.S., A.J.Z.), University of Minnesota, Minneapolis, Minnesota.,Department of Neurology, Stroke Institute (C.D.S., S.L.P., B.T.J., A.P.J., T.G.J., S.R., D.T.C.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania
| | - S Rangaraju
- Department of Neurology, Stroke Institute (C.D.S., S.L.P., B.T.J., A.P.J., T.G.J., S.R., D.T.C.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.,Department of Neurology (S.R.), Emory University, Atlanta, Georgia
| | - D T Campbell
- Department of Neurology, Stroke Institute (C.D.S., S.L.P., B.T.J., A.P.J., T.G.J., S.R., D.T.C.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.,Department of Neurology (D.T.C.), WellStar Kennestone Hospital, Marietta, Georgia
| | - D G Winger
- Clinical Translational Science Institute (D.G.W.), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - S L Paolini
- Department of Neurology, Stroke Institute (C.D.S., S.L.P., B.T.J., A.P.J., T.G.J., S.R., D.T.C.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania
| | - A J Zhang
- From the Department of Neurology (C.D.S., A.J.Z.), University of Minnesota, Minneapolis, Minnesota
| | - B T Jankowitz
- Department of Neurology, Stroke Institute (C.D.S., S.L.P., B.T.J., A.P.J., T.G.J., S.R., D.T.C.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania
| | - A P Jadhav
- Department of Neurology, Stroke Institute (C.D.S., S.L.P., B.T.J., A.P.J., T.G.J., S.R., D.T.C.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania
| | - T G Jovin
- Department of Neurology, Stroke Institute (C.D.S., S.L.P., B.T.J., A.P.J., T.G.J., S.R., D.T.C.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania
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16
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Swimm A, Giver CR, DeFilipp Z, Rangaraju S, Sharma A, Ulezko Antonova A, Sonowal R, Capaldo C, Powell D, Qayed M, Kalman D, Waller EK. Indoles derived from intestinal microbiota act via type I interferon signaling to limit graft-versus-host disease. Blood 2018; 132:2506-2519. [PMID: 30257880 PMCID: PMC6284212 DOI: 10.1182/blood-2018-03-838193] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [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: 03/06/2018] [Accepted: 09/19/2018] [Indexed: 01/05/2023] Open
Abstract
The intestinal microbiota in allogeneic bone marrow transplant (allo-BMT) recipients modulates graft-versus-host disease (GVHD), a systemic inflammatory state initiated by donor T cells that leads to colitis, a key determinant of GVHD severity. Indole or indole derivatives produced by tryptophan metabolism in the intestinal microbiota limit intestinal inflammation caused by diverse stressors, so we tested their capacity to protect against GVHD in murine major histocompatibility complex-mismatched models of allo-BMT. Indole effects were assessed by colonization of allo-BMT recipient mice with tryptophanase positive or negative strains of Escherichia coli, or, alternatively, by exogenous administration of indole-3-carboxaldehyde (ICA), an indole derivative. Treatment with ICA limited gut epithelial damage, reduced transepithelial bacterial translocation, and decreased inflammatory cytokine production, reducing GVHD pathology and GVHD mortality, but did not compromise donor T-cell-mediated graft-versus-leukemia responses. ICA treatment also led to recipient-strain-specific tolerance of engrafted T cells. Transcriptional profiling and gene ontology analysis indicated that ICA administration upregulated genes associated with the type I interferon (IFN1) response, which has been shown to protect against radiation-induced intestinal damage and reduce subsequent GVHD pathology. Accordingly, protective effects of ICA following radiation exposure were abrogated in mice lacking IFN1 signaling. Taken together, these data indicate that indole metabolites produced by the intestinal microbiota act via type I IFNs to limit intestinal inflammation and damage associated with myeloablative chemotherapy or radiation exposure and acute GVHD, but preserve antitumor responses, and may provide a therapeutic option for BMT patients at risk for GVHD.
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Affiliation(s)
- Alyson Swimm
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Cynthia R Giver
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Sravanti Rangaraju
- Department of Hematology and Oncology, Indiana University, Indianapolis, IN
| | - Akshay Sharma
- Pediatric Hematology and Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Alina Ulezko Antonova
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Robert Sonowal
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Christopher Capaldo
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Domonica Powell
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
- Immunology and Molecular Pathogenesis Graduate Program, Emory University School of Medicine, Atlanta, GA; and
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University, Atlanta, GA
| | - Daniel Kalman
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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17
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Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S, Wakhloo A, Moonis M, Henniger N, Goddeau R, van den Berg R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Tunguturi A, Onteddu S, Carandang R, Howk M, Koudstaal PJ, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Meler P, Huerga E, Gelabert S, Coscojuela P, van Zwam WH, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Rovira A, Molina CA, Millán M, Muñoz L, Roos YB, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, García Bermejo P, Remollo S, Castaño C, García-Sort R, van der Lugt A, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Dávalos A, Chamorro A, Urra X, Obach V, van Oostenbrugge RJ, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Ariño H, Aceituno A, Rudilosso S, Renu A, Majoie CB, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Quesada H, Rubio F, Cano L, Lara B, Dippel DW, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Brown MM, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Liebig T, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Stijnen T, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Mutlu G, Rosso C, Szatmary Z, Yger M, Andersson T, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Leautaud A, Renkes C, Serre I, Desal H, Mattle H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Wahlgren N, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, van der Heijden E, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Birchenall J, Bodiguel E, Calvet D, Domigo V, Ghannouti N, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Trystram D, Turc G, Berge J, Sibon I, Fleitour N, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Hooijenga I, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, Bejot Y, Chavent A, Gentil A, Kazemi A, Puppels C, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Pellikaan W, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Geerling A, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, Gory B, Manera L, Mechtouff L, Ritzenthaler T, Riva R, Lindl-Velema A, Salaris Silvio F, Tilikete C, Blanc R, Obadia M, Bartolini MB, Gueguen A, Piotin M, Pistocchi S, Redjem H, Drouineau J, van Vemde G, Neau JP, Godeneche G, Lamy M, Marsac E, Velasco S, Clavelou P, Chabert E, Bourgois N, Cornut-Chauvinc C, Ferrier A, de Ridder A, Gabrillargues J, Jean B, Marques AR, Vitello N, Detante O, Barbieux M, Boubagra K, Favre Wiki I, Garambois K, Tahon F, Greebe P, Ashok V, Voguet C, Coskun O, Guedin P, Rodesch G, Lapergue B, Bourdain F, Evrard S, Graveleau P, Decroix JP, de Bont-Stikkelbroeck J, Wang A, Sellal F, Ahle G, Carelli G, Dugay MH, Gaultier C, Lebedinsky AP, Lita L, Musacchio RM, Renglewicz-Destuynder C, de Meris J, Tournade A, Vuillemet F, Montoro FM, Mounayer C, Faugeras F, Gimenez L, Labach C, Lautrette G, Denier C, Saliou G, Janssen K, Chassin O, Dussaule C, Melki E, Ozanne A, Puccinelli F, Sachet M, Sarov M, Bonneville JF, Moulin T, Biondi A, Struijk W, De Bustos Medeiros E, Vuillier F, Courtheoux P, Viader F, Apoil-Brissard M, Bataille M, Bonnet AL, Cogez J, Kazemi A, Touze E, Licher S, Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Deplanque D, Girot M, Henon H, Kalsoum E, Boodt N, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Machi P, Mourand I, Riquelme C, Bounolleau P, Ros A, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Venema E, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Slokkers I, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Freeman J, Ford I, Markus H, Wardlaw J, Ganpat RJ, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, Perry R, Dixit A, Cloud G, Clifton A, Mulder M, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Kandasamy N, Goddard T, Bamford J, Subramanian G, Saiedie N, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala R, Banaras A, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Heshmatollah A, Harrison L, Keshvara R, Cunningham J, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, 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M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Dávalos A, Majoie CBLM, van der Lugt A, Ford GA, de la Ossa NP, Kelly M, Bourcier R, Donnan GA, Roos YBWEM, Bang OY, Nogueira RG, Devlin TG, van den Berg LA, Clarençon F, Burns P, Carpenter J, Berkhemer OA, Yavagal DR, Pereira VM, Ducrocq X, Dixit A, Quesada H, Epstein J, Davis SM, Jansen O, Rubiera M, Urra X, Micard E, Lingsma HF, Naggara O, Brown S, Guillemin F, Muir KW, van Oostenbrugge RJ, Saver JL, Jovin TG, Hill MD, Mitchell PJ, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer 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Cunningham J, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez- Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Katkish LA, Rangaraju S, Rector TS, Gravely AA, Johnson GJ, Klein MA, Gupta P. Incidence of unprovoked venous thromboembolic events in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2017. [PMID: 28651451 DOI: 10.1080/10428194.2017.1341979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lauren A Katkish
- a Department of Medicine , University of Minnesota , Minneapolis , MN , USA
| | - Sravanti Rangaraju
- a Department of Medicine , University of Minnesota , Minneapolis , MN , USA
| | - Thomas S Rector
- a Department of Medicine , University of Minnesota , Minneapolis , MN , USA.,b Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System , Minneapolis , MN , USA
| | - Amy A Gravely
- b Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System , Minneapolis , MN , USA
| | - Gerhard J Johnson
- c Hematology/Oncology Section , Minneapolis VA Health Care System , Minneapolis , MN , USA.,d Hematology/Oncology/Transplantation Division, Department of Medicine , University of Minnesota , Minneapolis , MN , USA
| | - Mark A Klein
- c Hematology/Oncology Section , Minneapolis VA Health Care System , Minneapolis , MN , USA.,d Hematology/Oncology/Transplantation Division, Department of Medicine , University of Minnesota , Minneapolis , MN , USA
| | - Pankaj Gupta
- c Hematology/Oncology Section , Minneapolis VA Health Care System , Minneapolis , MN , USA.,d Hematology/Oncology/Transplantation Division, Department of Medicine , University of Minnesota , Minneapolis , MN , USA
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Dehkharghani S, Bammer R, Straka M, Bowen M, Allen JW, Rangaraju S, Kang J, Gleason T, Brasher C, Nahab F. Performance of CT ASPECTS and Collateral Score in Risk Stratification: Can Target Perfusion Profiles Be Predicted without Perfusion Imaging? AJNR Am J Neuroradiol 2016; 37:1399-404. [PMID: 26965466 DOI: 10.3174/ajnr.a4727] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/10/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular trials suggest that revascularization benefits a subset of acute ischemic stroke patients with large-artery occlusion and small-core infarct volumes. The objective of our study was to identify thresholds of noncontrast CT-ASPECTS and collateral scores on CT angiography that best predict ischemic core volume thresholds quantified by CT perfusion among patients with acute ischemic stroke. MATERIALS AND METHODS Fifty-four patients with acute ischemic stroke (<12 hours) and MCA/intracranial ICA occlusion underwent NCCT/CTP during their initial evaluation. CTP analysis was performed on a user-independent platform (RApid processing of PerfusIon and Diffusion), computing core infarct (defined as CBF of <30% normal). A target mismatch profile consisting of infarction core of ≤50 mL was selected to define candidates with acute ischemic stroke likely to benefit from revascularization. RESULTS NCCT-ASPECTS of ≥9 with a CTA collateral score of 3 had 100% specificity for identifying patients with a CBF core volume of ≤50 mL. NCCT-ASPECTS of ≤6 had 100% specificity for identifying patients with a CBF core volume of >50 mL. In our cohort, 44 (81%) patients had an NCCT-ASPECTS of ≥9, a CTA collateral score of 3, or an NCCT-ASPECTS of ≤6. CONCLUSIONS Using an NCCT-ASPECTS of ≥9 or a CTA collateral score of 3 best predicts CBF core volume infarct of ≤50 mL, while an NCCT-ASPECTS of ≤6 best predicts a CBF core volume infarct of >50 mL. Together these thresholds suggest that a specific population of patients with acute ischemic stroke not meeting such profiles may benefit most from CTP imaging to determine candidacy for revascularization.
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Affiliation(s)
- S Dehkharghani
- From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.) Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia
| | - R Bammer
- Department of Radiology (R.B.), Stanford University Hospital, Stanford, California
| | - M Straka
- Institut für Radiologie und Nuklearmedizin (M.S.), Kantonsspital Winterthur, Winterthur, Switzerland
| | - M Bowen
- From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.)
| | - J W Allen
- From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.) Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia
| | - S Rangaraju
- Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia
| | - J Kang
- Department of Biostatistics (J.K.), University of Michigan, Ann Arbor, Michigan
| | - T Gleason
- From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.)
| | - C Brasher
- Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia
| | - F Nahab
- Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia
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Swiatkowski P, Murugan M, Eyo UB, Wang Y, Rangaraju S, Oh SB, Wu LJ. Activation of microglial P2Y12 receptor is required for outward potassium currents in response to neuronal injury. Neuroscience 2016; 318:22-33. [PMID: 26791526 DOI: 10.1016/j.neuroscience.2016.01.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 12/13/2022]
Abstract
Microglia, the resident immune cells in the central nervous system (CNS), constantly survey the surrounding neural parenchyma and promptly respond to brain injury. Activation of purinergic receptors such as P2Y12 receptors (P2Y12R) in microglia has been implicated in chemotaxis toward ATP that is released by injured neurons and astrocytes. Activation of microglial P2Y12R elicits outward potassium current that is associated with microglial chemotaxis in response to injury. This study aimed at investigating the identity of the potassium channel implicated in microglial P2Y12R-mediated chemotaxis following neuronal injury and understanding the purinergic signaling pathway coupled to the channel. Using a combination of two-photon imaging, electrophysiology and genetic tools, we found the ATP-induced outward current to be largely dependent on P2Y12R activation and mediated by G-proteins. Similarly, P2Y12R-coupled outward current was also evoked in response to laser-induced single neuron injury. This current was abolished in microglia obtained from mice lacking P2Y12R. Dissecting the properties of the P2Y12R-mediated current using a pharmacological approach revealed that both the ATP and neuronal injury-induced outward current in microglia was sensitive to quinine (1mM) and bupivacaine (400μM), but not tetraethylammonium (TEA) (10mM) and 4-aminopyridine (4-AP) (5mM). These results suggest that the quinine/bupivacaine-sensitive potassium channels are the functional effectors of the P2Y12R-mediated signaling in microglia activation following neuronal injury.
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Affiliation(s)
- P Swiatkowski
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, United States; Program in Cellular and Molecular Pharmacology, Rutgers University, Piscataway, NJ 08854, United States
| | - M Murugan
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, United States
| | - U B Eyo
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, United States
| | - Y Wang
- Stomatological Hospital, Anhui Medical University, Hefei, Anhui 230032, China
| | - S Rangaraju
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA 30329, United States
| | - S B Oh
- Department of Neurobiology and Physiology, School of Dentistry, Seoul National University, Seoul, South Korea
| | - L-J Wu
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, United States.
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Dehkharghani S, Bammer R, Straka M, Albin LS, Kass-Hout O, Allen JW, Rangaraju S, Qiu D, Winningham MJ, Nahab F. Performance and Predictive Value of a User-Independent Platform for CT Perfusion Analysis: Threshold-Derived Automated Systems Outperform Examiner-Driven Approaches in Outcome Prediction of Acute Ischemic Stroke. AJNR Am J Neuroradiol 2015; 36:1419-25. [PMID: 25999410 DOI: 10.3174/ajnr.a4363] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/20/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Treatment strategies in acute ischemic stroke aim to curtail ischemic progression. Emerging paradigms propose patient subselection using imaging biomarkers derived from CT, CTA, and CT perfusion. We evaluated the performance of a fully-automated computational tool, hypothesizing enhancements compared with qualitative approaches. The correlation between imaging variables and clinical outcomes in a cohort of patients with acute ischemic stroke is reported. MATERIALS AND METHODS Sixty-two patients with acute ischemic stroke and MCA or ICA occlusion undergoing multidetector CT, CTA, and CTP were retrospectively evaluated. CTP was processed on a fully operator-independent platform (RApid processing of PerfusIon and Diffusion [RAPID]) computing automated core estimates based on relative cerebral blood flow and relative cerebral blood volume and hypoperfused tissue volumes at varying thresholds of time-to-maximum. Qualitative analysis was assigned by 2 independent reviewers for each variable, including CT-ASPECTS, CBV-ASPECTS, CBF-ASPECTS, CTA collateral score, and CTA clot burden score. Performance as predictors of favorable clinical outcome and final infarct volume was established for each variable. RESULTS Both RAPID core estimates, CT-ASPECTS, CBV-ASPECTS, and clot burden score correlated with favorable clinical outcome (P < .05); CBF-ASPECTS and collateral score were not significantly associated with favorable outcome, while hypoperfusion estimates were variably associated, depending on the selected time-to-maximum thresholds. Receiver operating characteristic analysis demonstrated disparities among tested variables, with RAPID core and hypoperfusion estimates outperforming all qualitative approaches (area under the curve, relative CBV = 0.86, relative CBF = 0.81; P < .001). CONCLUSIONS Qualitative approaches to acute ischemic stroke imaging are subject to limitations due to their subjective nature and lack of physiologic information. These findings support the benefits of high-speed automated analysis, outperforming conventional methodologies while limiting delays in clinical management.
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Affiliation(s)
- S Dehkharghani
- From the Departments of Radiology and Imaging Sciences (S.D., L.S.A., J.W.A., D.Q.)
| | - R Bammer
- Department of Radiology (R.B.), Stanford University Hospital, Stanford, California
| | - M Straka
- Institut für Radiologie und Nuklearmedizin (M.S.), Kantonsspital Winterthur, Winterthur, Switzerland
| | - L S Albin
- From the Departments of Radiology and Imaging Sciences (S.D., L.S.A., J.W.A., D.Q.)
| | - O Kass-Hout
- Department of Neurology (O.K.-H.), Catholic Health System, Buffalo, New York
| | - J W Allen
- From the Departments of Radiology and Imaging Sciences (S.D., L.S.A., J.W.A., D.Q.)
| | - S Rangaraju
- Neurology (S.R., M.J.W., F.N.), Emory University Hospital, Atlanta, Georgia
| | - D Qiu
- From the Departments of Radiology and Imaging Sciences (S.D., L.S.A., J.W.A., D.Q.)
| | - M J Winningham
- Neurology (S.R., M.J.W., F.N.), Emory University Hospital, Atlanta, Georgia
| | - F Nahab
- Neurology (S.R., M.J.W., F.N.), Emory University Hospital, Atlanta, Georgia
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Mikell JL, Waller EK, Switchenko JM, Rangaraju S, Ali Z, Graiser M, Hall WA, Langston AA, Esiashvili N, Khoury HJ, Khan MK. Similar survival for patients undergoing reduced-intensity total body irradiation (TBI) versus myeloablative TBI as conditioning for allogeneic transplant in acute leukemia. Int J Radiat Oncol Biol Phys 2014; 89:360-9. [PMID: 24837891 DOI: 10.1016/j.ijrobp.2014.02.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/28/2014] [Accepted: 02/21/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE Hematopoietic stem cell transplantation (HSCT) is the mainstay of treatment for adults with acute leukemia. Total body irradiation (TBI) remains an important part of the conditioning regimen for HCST. For those patients unable to tolerate myeloablative TBI (mTBI), reduced intensity TBI (riTBI) is commonly used. In this study we compared outcomes of patients undergoing mTBI with those of patients undergoing riTBI in our institution. METHODS AND MATERIALS We performed a retrospective review of all patients with acute leukemia who underwent TBI-based conditioning, using a prospectively acquired database of HSCT patients treated at our institution. Patient data including details of the transplantation procedure, disease status, Karnofsky performance status (KPS), response rates, toxicity, survival time, and time to progression were extracted. Patient outcomes for various radiation therapy regimens were examined. Descriptive statistical analysis was performed. RESULTS Between June 1985 and July 2012, 226 patients with acute leukemia underwent TBI as conditioning for HSCT. Of those patients, 180 had full radiation therapy data available; 83 had acute lymphoblastic leukemia and 94 had acute myelogenous leukemia; 45 patients received riTBI, and 135 received mTBI. Median overall survival (OS) was 13.7 months. Median relapse-free survival (RFS) for all patients was 10.2 months. Controlling for age, sex, KPS, disease status, and diagnosis, there were no significant differences in OS or RFS between patients who underwent riTBI and those who underwent mTBI (P=.402, P=.499, respectively). Median length of hospital stay was shorter for patients who received riTBI than for those who received mTBI (16 days vs 23 days, respectively; P<.001), and intensive care unit admissions were less frequent following riTBI than mTBI (2.22% vs 12.69%, respectively, P=.043). Nonrelapse survival rates were also similar (P=.186). CONCLUSIONS No differences in OS or RFS were seen between all patients undergoing riTBI and those undergoing mTBI, despite older age and potential increased comorbidity of riTBI patients. riTBI regimens were associated with shorter length of hospital stay, fewer intensive care unit admissions, and similar rates of nonrelapse survival, which may reflect reduced toxicity. Prospective trials comparing riTBI and mTBI are warranted.
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Affiliation(s)
- John L Mikell
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
| | - Edmund K Waller
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Sravanti Rangaraju
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Zahir Ali
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Michael Graiser
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - William A Hall
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Amelia A Langston
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - H Jean Khoury
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mohammad K Khan
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Nooka AK, Johnson HR, Kaufman JL, Flowers CR, Langston A, Steuer C, Graiser M, Ali Z, Shah NN, Rangaraju S, Nickleach D, Gao J, Lonial S, Waller EK. Pharmacoeconomic analysis of palifermin to prevent mucositis among patients undergoing autologous hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2014; 20:852-857. [PMID: 24607557 DOI: 10.1016/j.bbmt.2014.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
Trials have shown benefits of palifermin in reducing the incidence and severity of oral mucositis in patients with hematological malignancies undergoing autologous hematopoietic stem cell transplantation (HSCT) with total body irradiation (TBI)-based conditioning regimens. Similar outcome data are lacking for patients receiving non-TBI-based regimens. We performed a retrospective evaluation on the pharmacoeconomic benefit of palifermin in the setting of non-TBI-based conditioning and autologous HSCT. Between January 2002 and December 2010, 524 patients undergoing autologous HSCT for myeloma (melphalan 200 mg/m²) and lymphoma (high-dose busulfan, cyclophosphamide, and etoposide) as preparative regimen were analyzed. Use of patient-controlled analgesia (PCA) was significantly lower in the palifermin-treated groups (myeloma: 13% versus 53%, P < .001; lymphoma: 46% versus 68%, P < .001). Median total transplant charges were significantly higher in the palifermin-treated group, after controlling for inflation (myeloma: $167,820 versus $143,200, P < .001; lymphoma: $168,570 versus $148,590, P < .001). Palifermin treatment was not associated with a difference in days to neutrophil engraftment, length of stay, and overall survival and was associated with an additional cost of $5.5K (myeloma) and $14K (lymphoma) per day of PCA avoided. Future studies are suggested to evaluate the cost-effectiveness of palifermin compared with other symptomatic treatments to reduce transplant toxicity using validated measures for pain and quality of life.
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Affiliation(s)
- Ajay K Nooka
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Heather R Johnson
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Jonathan L Kaufman
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Amelia Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Michael Graiser
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Zahir Ali
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Nishi N Shah
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Sravanti Rangaraju
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Dana Nickleach
- Biostatistics & Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Jingjing Gao
- Biostatistics & Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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Noorian A, Rangaraju S, Owada K, Glenn B, Belagaje S, Anderson A, Frankel M, Gupta R, Nogueira R. E-040 Evaluation of peri-procedural blood loss in acute ischemic stroke patients undergoing endovascular revascularization. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.40] [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: 11/04/2022]
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26
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Noorian A, Rangaraju S, Owada K, Glenn B, Belagaje S, Anderson A, Frankel M, Gupta R, Nogueira R. E-039 Impact of contrast load for acute ischemic stroke endovascular therapy on renal function. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.39] [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: 11/04/2022]
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Rangaraju S, Owada K, Noorian A, Glenn B, Belagaje S, Anderson A, Nahab F, Frankel M, Nogueira R, Gupta R. O-020 A comparison of infarct volumes in patients with large vessel occlusions based on treatment modality: a retrospective analysis: Abstract O-020 Figure 1. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455a.20] [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: 11/04/2022]
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28
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Noorian A, Rangaraju S, Owada K, Jovin T, Glenn B, Belagaje S, Anderson A, Nahab F, Frankel M, Nogueira R, Gupta R. P-029 Outcomes in patients with ASPECTS of 5–7 undergoing endovascular reperfusion therapy for acute ischemic stroke. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455b.29] [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: 11/04/2022]
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Pennington MW, Beeton C, Galea CA, Smith BJ, Chi V, Monaghan KP, Garcia A, Rangaraju S, Giuffrida A, Plank D, Crossley G, Nugent D, Khaytin I, Lefievre Y, Peshenko I, Dixon C, Chauhan S, Orzel A, Inoue T, Hu X, Moore RV, Norton RS, Chandy KG. Engineering a stable and selective peptide blocker of the Kv1.3 channel in T lymphocytes. Mol Pharmacol 2009; 75:762-73. [PMID: 19122005 DOI: 10.1124/mol.108.052704] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Kv1.3 potassium channels maintain the membrane potential of effector memory (T(EM)) T cells that are important mediators of multiple sclerosis, type 1 diabetes mellitus, and rheumatoid arthritis. The polypeptide ShK-170 (ShK-L5), containing an N-terminal phosphotyrosine extension of the Stichodactyla helianthus ShK toxin, is a potent and selective blocker of these channels. However, a stability study of ShK-170 showed minor pH-related hydrolysis and oxidation byproducts that were exacerbated by increasing temperatures. We therefore engineered a series of analogs to minimize the formation of these byproducts. The analog with the greatest stability, ShK-192, contains a nonhydrolyzable phosphotyrosine surrogate, a methionine isostere, and a C-terminal amide. ShK-192 shows the same overall fold as ShK, and there is no evidence of any interaction between the N-terminal adduct and the rest of the peptide. The docking configuration of ShK-192 in Kv1.3 shows the N-terminal para-phosphonophenylalanine group lying at the junction of two channel monomers to form a salt bridge with Lys(411) of the channel. ShK-192 blocks Kv1.3 with an IC(50) of 140 pM and exhibits greater than 100-fold selectivity over closely related channels. After a single subcutaneous injection of 100 microg/kg, approximately 100 to 200 pM concentrations of active peptide is detectable in the blood of Lewis rats 24, 48, and 72 h after the injection. ShK-192 effectively inhibits the proliferation of T(EM) cells and suppresses delayed type hypersensitivity when administered at 10 or 100 microg/kg by subcutaneous injection once daily. ShK-192 has potential as a therapeutic for autoimmune diseases mediated by T(EM) cells.
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Affiliation(s)
- M W Pennington
- Bachem Bioscience Inc., King of Prussia, Pennsylvania, USA
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