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Aires D, Abhyankar S. Early intervention of extracorporeal photopheresis for advancing/progressing cutaneous T-cell lymphoma. Hematol Oncol 2023; 41:809-816. [PMID: 37974524 DOI: 10.1002/hon.3229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
Patients with cutaneous T-cell lymphoma with progressive disease typically undergo a series of skin-directed and systemic therapy regimens during cycles of response and relapse. Extracorporeal photopheresis (ECP) is an effective and safe systemic treatment option, often reserved for later stages of disease and typically employed after failure of several other therapies. ECP has benefits in response rate, time to next treatment, and tolerability that may support its use earlier in the treatment cycle for advancing/progressing disease.
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Affiliation(s)
| | - Sunil Abhyankar
- University of Kansas Cancer Center and the University of Kansas Medical Center, Kansas City, Kansas, USA
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Al Malki MM, London K, Baez J, Akahoshi Y, Hogan WJ, Etra A, Choe H, Hexner E, Langston A, Abhyankar S, Ponce DM, DeFilipp Z, Kitko CL, Adekola K, Reshef R, Ayuk F, Capellini A, Chanswangphuwana C, Eder M, Eng G, Gandhi I, Grupp S, Gleich S, Holler E, Javorniczky NR, Kasikis S, Kowalyk S, Morales G, Özbek U, Rösler W, Spyrou N, Yanik G, Young R, Chen YB, Nakamura R, Ferrara JLM, Levine JE. Phase 2 study of natalizumab plus standard corticosteroid treatment for high-risk acute graft-versus-host disease. Blood Adv 2023; 7:5189-5198. [PMID: 37235690 PMCID: PMC10505783 DOI: 10.1182/bloodadvances.2023009853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023] Open
Abstract
Graft-versus-host disease (GVHD) of the gastrointestinal (GI) tract is the main cause of nonrelapse mortality (NRM) after allogeneic hematopoietic cell transplantation. Ann Arbor (AA) scores derived from serum biomarkers at onset of GVHD quantify GI crypt damage; AA2/3 scores correlate with resistance to treatment and higher NRM. We conducted a multicenter, phase 2 study using natalizumab, a humanized monoclonal antibody that blocks T-cell trafficking to the GI tract through the α4 subunit of α4β7 integrin, combined with corticosteroids as primary treatment for patients with new onset AA2/3 GVHD. Seventy-five patients who were evaluable were enrolled and treated; 81% received natalizumab within 2 days of starting corticosteroids. Therapy was well tolerated with no treatment emergent adverse events in >10% of patients. Outcomes for patients treated with natalizumab plus corticosteroids were compared with 150 well-matched controls from the MAGIC database whose primary treatment was corticosteroids alone. There were no significant differences in overall or complete response between patients treated with natalizumab plus corticosteroids and those treated with corticosteroids alone (60% vs 58%; P = .67% and 48% vs 48%; P = 1.0, respectively) including relevant subgroups. There were also no significant differences in NRM or overall survival at 12 months in patients treated with natalizumab plus corticosteroids compared with controls treated with corticosteroids alone (38% vs 39%; P = .80% and 46% vs 54%; P = .48, respectively). In this multicenter biomarker-based phase 2 study, natalizumab combined with corticosteroids failed to improve outcome of patients with newly diagnosed high-risk GVHD. This trial was registered at www.clinicaltrials.gov as # NCT02133924.
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Affiliation(s)
- Monzr M. Al Malki
- Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Kaitlyn London
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Janna Baez
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yu Akahoshi
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Aaron Etra
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hannah Choe
- Division of Hematology, James Cancer Center, The Ohio State University, Columbus, OH
| | - Elizabeth Hexner
- Blood and Marrow Transplantation Program, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Sunil Abhyankar
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Doris M. Ponce
- Division of Hematology/Oncology, Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering, New York, NY
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - Carrie L. Kitko
- Pediatric Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, TN
| | - Kehinde Adekola
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ran Reshef
- Blood and Marrow Transplantation, Columbia University Medical Center, New York, NY
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Capellini
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chantiya Chanswangphuwana
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Matthias Eder
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Gilbert Eng
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Isha Gandhi
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephan Grupp
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sigrun Gleich
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Ernst Holler
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Nora Rebeka Javorniczky
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, Albert Ludwigs University, Freiburg, Germany
| | - Stelios Kasikis
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Kowalyk
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Morales
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Umut Özbek
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Wolf Rösler
- Department of Internal Medicine 5, University Hospital Erlangen, Erlangen, Germany
| | - Nikolaos Spyrou
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gregory Yanik
- Blood and Marrow Transplant Program, Michigan Medicine, Ann Arbor, MI
| | - Rachel Young
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yi-Bin Chen
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - Ryotaro Nakamura
- Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - James L. M. Ferrara
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John E. Levine
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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3
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Ahmed N, Wesson W, Mushtaq MU, Bansal R, AbdelHakim H, Bromert S, Appenfeller A, Ghazal BA, Singh A, Abhyankar S, Ganguly S, McGuirk J, Abdallah AO, Shune L. "Waitlist mortality" is high for myeloma patients with limited access to BCMA therapy. Front Oncol 2023; 13:1206715. [PMID: 37601685 PMCID: PMC10436079 DOI: 10.3389/fonc.2023.1206715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/29/2023] [Indexed: 08/22/2023] Open
Abstract
Background The first-in-class approved BCMA CAR-T therapy was idecabtagene vicleucel (ide-cel), approved in March 2021, for RRMM patients who progressed after 4 or more lines of therapy. Despite the promising outcomes, there were limited apheresis/production slots for ide-cel. We report outcomes of patients at our institution who were on the "waitlist" to receive ide-cel in 2021 and who could not secure a slot. Methods We conducted a retrospective review of RRMM patients evaluated at the University of Kansas Cancer Center for ide-cel from 3/2021-7/2021. A retrospective chart review was performed to determine patient and disease characteristics. Descriptive statistics were reported using medians for continuous variables. Survival analysis from initial consult was performed using Kaplan-Meier Survival estimator. Results Forty patients were eligible and were on the "waitlist" for CAR-T. The median follow-up was 14 months (2-25mo). Twenty-four patients (60%) secured a production slot and 16 (40%) did not. The median time from consult to collection was 38 days (8-703). The median time from collection to infusion was 42 days (34-132 days). The median overall survival was higher in the CAR-T group (NR vs 9 mo, p<0.001). Conclusions Many patients who were eligible for ide-cel were not able to secure a timely slot in 2021. Mortality was higher in this group, due to a lack of comparable alternatives. Increasing alternate options as well as improvement in manufacturing and access is an area of high importance to improve RRMM outcomes.
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Affiliation(s)
- Nausheen Ahmed
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - William Wesson
- School of Medicine, University of Kansas, Kansas, KS, United States
| | - Muhammad Umair Mushtaq
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - Rajat Bansal
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - Haitham AbdelHakim
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - Sarah Bromert
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - Allison Appenfeller
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - Batool Abu Ghazal
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - Anurag Singh
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - Sunil Abhyankar
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - Siddhartha Ganguly
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
- Mary and Ron Neal Cancer Center, Houston Methodist Hospital, Houston, TX, United States
| | - Joseph McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - Al-Ola Abdallah
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
| | - Leyla Shune
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States
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Umbaugh DS, Soder RP, Nguyen NT, Adelusi O, Robarts DR, Woolbright B, Duan L, Abhyankar S, Dawn B, Apte U, Jaeschke H, Ramachandran A. Human Wharton's Jelly-derived mesenchymal stem cells prevent acetaminophen-induced liver injury in a mouse model unlike human dermal fibroblasts. Arch Toxicol 2022; 96:3315-3329. [PMID: 36057886 PMCID: PMC9773902 DOI: 10.1007/s00204-022-03372-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/12/2022] [Accepted: 08/25/2022] [Indexed: 12/24/2022]
Abstract
The persistence of hepatotoxicity induced by N-acetyl-para-aminophenol (Acetaminophen or Paracetamol, abbreviated as APAP) as the most common cause of acute liver failure in the United States, despite the availability of N-acetylcysteine, illustrates the clinical relevance of additional therapeutic approaches. While human mesenchymal stem cells (MSCs) have shown protection in mouse models of liver injury, the MSCs used are generally not cleared for human use and it is unclear whether these effects are due to xenotransplantation. Here we evaluated GMP manufactured clinical grade human Wharton's Jelly mesenchymal stem cells (WJMSCs), which are currently being investigated in human clinical trials, in a mouse model of APAP hepatotoxicity in comparison to human dermal fibroblasts (HDFs) to address these issues. C57BL6J mice were treated with a moderate APAP overdose (300 mg/kg) and WJMSCs were administered 90 min later. Liver injury was evaluated at 6 and 24 h after APAP. WJMSCs treatment reduced APAP-induced liver injury at both time points unlike HDFs, which showed no protection. APAP-induced JNK activation as well as AIF and Smac release from mitochondria were prevented by WJMSCs treatment without influencing APAP bioactivation. Mechanistically, WJMSCs treatment upregulated expression of Gclc and Gclm to enhance recovery of liver GSH levels to attenuate mitochondrial dysfunction and accelerated recovery of pericentral hepatocytes to re-establish liver zonation and promote liver homeostasis. Notably, preventing GSH resynthesis with buthionine sulfoximine prevented the protective effects of WJMSCs. These data indicate that these GMP-manufactured WJMCs could be a clinically relevant therapeutic approach in the management of APAP hepatotoxicity in humans.
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Affiliation(s)
- David S Umbaugh
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, KS, 66160, USA
| | - Rupal P Soder
- Midwest Stem Cell Therapy Center, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1075, Kansas City, KS, 66160, USA
| | - Nga T Nguyen
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, KS, 66160, USA
| | - Olamide Adelusi
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, KS, 66160, USA
| | - Dakota R Robarts
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, KS, 66160, USA
| | - Ben Woolbright
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, KS, 66160, USA
| | - Luqi Duan
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, KS, 66160, USA
| | - Sunil Abhyankar
- Midwest Stem Cell Therapy Center, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1075, Kansas City, KS, 66160, USA
- Blood and Marrow Transplant Program, Division of Hematologic Malignancies and Cellular Therapeutics Center, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, KS, 66160, USA
| | - Buddhadeb Dawn
- Midwest Stem Cell Therapy Center, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1075, Kansas City, KS, 66160, USA
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, USA
| | - Udayan Apte
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, KS, 66160, USA
| | - Hartmut Jaeschke
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, KS, 66160, USA
| | - Anup Ramachandran
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1018, Kansas City, KS, 66160, USA.
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Maakaron JE, Zhang MJ, Chen K, Abhyankar S, Bhatt VR, Chhabra S, El Jurdi N, Farag SS, He F, Juckett M, de Lima M, Majhail N, van der Poel M, Saad A, Savani B, Ustun C, Waller EK, Litzow M, Kebriaei P, Hourigan CS, Saber W, Weisdorf D. Age is no barrier for adults undergoing HCT for AML in CR1: contemporary CIBMTR analysis. Bone Marrow Transplant 2022; 57:911-917. [PMID: 35368040 PMCID: PMC9232949 DOI: 10.1038/s41409-022-01650-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
Acute Myeloid Leukemia (AML) has a median age at diagnosis of 67 years. The most common curative therapy remains an allogeneic hematopoietic stem cell transplantation (HCT), yet it is complicated by treatment-related mortality (TRM) and ongoing morbidity including graft versus host disease (GVHD) that may impact survival, particularly in older patients. We examined the outcomes and predictors of success in 1,321 patients aged 60 years and older receiving a HCT for AML in first complete remission (CR1) from 2007–2017 and reported to the CIBMTR. Outcomes were compared in three age cohorts (60–64; 65–69; 70+). With median follow-up of nearly 3 years, patients aged 60–64 had modestly, though significantly better OS, DFS and lower TRM than those either 65–69 or 70+; cohorts with similar outcomes. Three-year OS for the 3 cohorts was 49.4%, 42.3%, and 44.7% respectively (p=0.026). TRM was higher with increasing age, cord blood as graft source and HCT-CI score of ≥ 3. Conditioning intensity was not a significant predictor of OS in the 60–69 cohort with 3-year OS of 46% for RIC and 49% for MAC (p=0.38); MAC was rarely used over age 70. There was no difference in the relapse rate, incidence of Grade III/IV acute GVHD, or moderate-severe chronic GVHD across the age cohorts. After adjusting for other predictors, age had a small effect on OS and TRM. High-risk features including poor cytogenetics and measurable residual disease (MRD) prior to HCT were each significantly associated with relapse and accounted for most of the adverse impact on OS and DFS. Age did not influence the incidence of either acute or chronic GVHD; while graft type and associated GVHD prophylaxis were most important. These data suggest that age alone is not a barrier to successful HCT for AML in CR1 and should not exclude patients from HCT. Efforts should focus on minimizing residual disease and better donor selection.
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Shahzad M, Chaudhary SG, Iqbal Q, Tariq E, Hussain A, Altaf S, Anwar I, Ahmed N, Abhyankar S, Hematti P, McGuirk JP, Mushtaq MU. Outcomes with Allogeneic Hematopoietic Stem Cell Transplantation in TP53-Mutated Myelodysplastic Syndromes: A Systematic Review and Meta-Analysis. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00311-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shahzad M, Arslan M, Naseem Z, Fatima N, Abbas S, Hussain A, Ali T, Anwar I, Siddiqui R, Chaudhary SG, Ahmed N, Abhyankar S, Hematti P, McGuirk JP, Mushtaq MU. Top 100 Cited Articles on Hematopoietic Stem Cell Transplantation: A Bibliometric Analysis. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Thammineni VS, Shahzad M, Hassan MA, Khan MH, Khan A, Hussain A, Ahmed S, Aijaz Z, Anwar I, Chaudhary SG, Ahmed N, Abhyankar S, Callander NS, McGuirk JP, Hematti P, Mushtaq MU. Impact of CD34+ Graft Cell Dose on Outcomes after Allogeneic Peripheral Blood Stem Cell Transplantation: A Systemic Review and Meta-Analysis. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mushtaq MU, Nelson M, Bivona CR, Godwin A, Sharma P, Martin G, Li K, Streeter N, Zhang J, Abdelhakim H, Hoffmann M, Liu B, Zheng C, Mitchell L, Pessetto Z, Pathak H, Abhyankar S, Khan Q, McGuirk JP. Immunogenicity of Sars-Cov-2 Vaccination in Hematopoietic Stem Cell Transplant and Chimeric Antigen Receptor T-Cell Therapy Recipients. Transplant Cell Ther 2022. [PMCID: PMC8930038 DOI: 10.1016/s2666-6367(22)00215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Iqbal Q, Shahzad M, Tariq E, Khan MH, Inam F, Hussain M, Chaudhary SG, Anwar I, Abhyankar S, Hematti P, Callander NS, Ahmed N, Shune L, McGuirk JP, Mushtaq MU. Outcomes of Autologous Stem Cell Transplantation in Primary Plasma Cell Leukemia: A Systematic Review and Meta-Analysis. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00689-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ahmed N, Abdallah AO, Bromert S, Appenfeller A, Abdelhakim H, Bansal R, Mahmoudjafari Z, Mushtaq MU, Singh AK, Abhyankar S, Ganguly S, McGuirk JP, Shune L. Single Institution Experience with Myeloma Patients for Commercially Approved BCMA Chimeric Antigen Receptor T Cell Therapy (CART) Idecabtagene-Vicleucel (Ide-cel). Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00457-2] [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: 11/26/2022]
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Zeiser R, Socié G, Schroeder MA, Abhyankar S, Vaz CP, Kwon M, Clausen J, Volodin L, Giebel S, Chacon MJ, Meyers G, Ghosh M, Deeren D, Sanz J, Morariu-Zamfir R, Arbushites M, Lakshminarayanan M, Barbour AM, Chen YB. Efficacy and safety of itacitinib versus placebo in combination with corticosteroids for initial treatment of acute graft-versus-host disease (GRAVITAS-301): a randomised, multicentre, double-blind, phase 3 trial. Lancet Haematol 2022; 9:e14-e25. [DOI: 10.1016/s2352-3026(21)00367-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 12/21/2022]
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13
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Soder RP, Dawn B, Weiss ML, Dunavin N, Weir S, Mitchell J, Li M, Shune L, Singh AK, Ganguly S, Morrison M, Abdelhakim H, Godwin AK, Abhyankar S, McGuirk J. A Phase I Study to Evaluate Two Doses of Wharton's Jelly-Derived Mesenchymal Stromal Cells for the Treatment of De Novo High-Risk or Steroid-Refractory Acute Graft Versus Host Disease. Stem Cell Rev Rep 2021; 16:979-991. [PMID: 32740891 DOI: 10.1007/s12015-020-10015-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Because of their well-described immunosuppressive properties, allogeneic adult human mesenchymal stromal cells (MSC) derived from bone marrow have demonstrated safety and efficacy in steroid refractory acute graft versus host disease (SR aGVHD). Clinical trials have resulted in variable success and an optimal source of MSC has yet to be defined. Based on the importance of maternal-fetal interface immune tolerance, extraembryonic fetal tissues, such as the umbilical cord, may provide an superior tissue source of MSC to mediate immunomodulation in aGVHD. METHODS A two-dose cohort trial allogeneic Wharton's Jelly-derived mesenchymal stromal cells (WJMSC, referred to as MSCTC-0010, here) were tested in 10 patients with de novo high risk (HR) or SR aGVHD post allogeneic hematopoietic stem cell transplantation (allo-HCT). Following Good Manufacturing Practices isolation, expansion and cryostorage, WJMSC were thawed and administered via intravenous infusions on days 0 and 7 at one of two doses (low dose cohort, 2 × 106/kg, n = 5; high dose cohort, 10 × 106/kg, n = 5). To evaluate safety, patients were monitored for infusion related toxicity, Treatment Related Adverse Events (TRAE) til day 42, or ectopic tissue formation at day 90. Clinical responses were monitored at time points up to 180 days post infusion. Serum biomarkers ST2 and REG3α were acquired 1 day prior to first MSCTC-0010 infusion and on day 14. RESULTS Safety was indicated, e.g., no infusion-related toxicity, no development of TRAE, nor ectopic tissue formation in either low or high dose cohort was observed. Clinical response was suggested at day 28: the overall response rate (ORR) was 70%, 4 of 10 patients had a complete response (CR) and 3 had a partial response (PR). By study day 90, the addition of escalated immunosuppressive therapy was necessary in 2 of 9 surviving patients. Day 100 and 180 post infusion survival was 90% and 60%, respectively. Serum biomarker REG3α decreased, particularly in the high dose cohort, and with REG3α decrease correlated with clinical response. CONCLUSIONS Treatment of patients with de novo HR or SR aGVHD with low or high dose MSCTC-0010 was safe: the infusion was well-tolerated, and no TRAEs or ectopic tissue formation was observed. A clinical improvement was seen in about 70% patients, with 4 of 10 showing a complete response that may have been attributable to MSCTC-0010 infusions. These observations indicate safety of two different doses of MSCTC-0010, and suggest that the 10 × 106 cells/ kg dose be tested in an expanded randomized, controlled Phase 2 trial. Graphical abstract.
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Affiliation(s)
- Rupal P Soder
- Midwest Stem Cell Therapy Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Buddhadeb Dawn
- University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Mark L Weiss
- Midwest Institute of Comparative Stem Cell Biotechnology and Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Neil Dunavin
- University of California, San Francisco, CA, USA
| | - Scott Weir
- Institute for Advancing Medical Innovation Medical Center, University of Kansas, Kansas City, USA
| | - James Mitchell
- Midwest Stem Cell Therapy Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Meizhang Li
- Pathology & Laboratory Medicine, Univeristy of Kansas Medical Center, Kansas City, USA
| | - Leyla Shune
- Blood and Marrow Transplant Program, Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Suite 210, Westwood, KS, 66205, USA
| | - Anurag K Singh
- Blood and Marrow Transplant Program, Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Suite 210, Westwood, KS, 66205, USA
| | - Siddhartha Ganguly
- Blood and Marrow Transplant Program, Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Suite 210, Westwood, KS, 66205, USA
| | - Marc Morrison
- Blood and Marrow Transplant Program, Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Suite 210, Westwood, KS, 66205, USA
| | - Haitham Abdelhakim
- Blood and Marrow Transplant Program, Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Suite 210, Westwood, KS, 66205, USA
| | - Andrew K Godwin
- Pathology & Laboratory Medicine, Univeristy of Kansas Medical Center, Kansas City, USA
| | - Sunil Abhyankar
- Midwest Stem Cell Therapy Center, University of Kansas Medical Center, Kansas City, KS, USA
- Blood and Marrow Transplant Program, Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Suite 210, Westwood, KS, 66205, USA
| | - Joseph McGuirk
- Blood and Marrow Transplant Program, Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Suite 210, Westwood, KS, 66205, USA.
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14
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Gyurkocza B, Nath R, Choe H, Seropian SE, Stiff P, Agura E, Abhyankar S, Litzow MR, Tomlinson B, Abboud C, Chen GL, Hari P, Orozco JJ, Sabloff M, Al-Kadhimi Z, Van Besien K, Silverman M, Foran J, Schuster MW, Kebriaei P, Levy MY, Lazarus HM, Giralt SA, Liang Q, Berger MS, Reddy V, Pagel JM. Targeted Radioimmunotherapy with Anti-CD45 Iodine (131I) Apamistamab [Iomab-B] in Older Patients with Active, Relapsed or Refractory (R/R) Acute Myeloid Leukemia Results in Successful and Timely Engraftment Not Related to the Radiation Dose Delivered. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00086-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Li M, Soder R, Abhyankar S, Abdelhakim H, Braun MW, Trinidad CV, Pathak HB, Pessetto Z, Deighan C, Ganguly S, Dawn B, McGuirk J, Dunavin N, Godwin AK. WJMSC-derived small extracellular vesicle enhance T cell suppression through PD-L1. J Extracell Vesicles 2021; 10:e12067. [PMID: 33598108 PMCID: PMC7869022 DOI: 10.1002/jev2.12067] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/04/2020] [Accepted: 01/13/2021] [Indexed: 12/30/2022] Open
Abstract
Both mesenchymal stem cells (MSCs) and their corresponding small extracellular vesicles (sEVs, commonly referred to as exosomes) share similar immunomodulatory properties that are potentially beneficial for the treatment of acute graft versus host disease (aGvHD). We report that clinical grade Wharton's Jelly‐derived MSCs (WJMSCs) secrete sEVs enriched in programmed death‐ligand 1 (PD‐L1), an essential ligand for an inhibitory immune checkpoint. A rapid increase in circulating sEV‐associated PD‐L1 was observed in patients with aGvHD and was directly associated with the infusion time of clinical grade WJMSCs. In addition, in vitro inhibitory antibody mediated blocking of sEV‐associated PD‐L1 restored T cell activation (TCA), suggesting a functional inhibitory role of sEVs‐PD‐L1. PD‐L1‐deficient sEVs isolated from WJMSCs following CRISPR‐Cas9 gene editing fail to inhibit TCA. Furthermore, we found that PD‐L1 is essential for WJMSC‐derived sEVs to modulate T cell receptors (TCRs). Our study reveals an important mechanism by which therapeutic WJMSCs modulate TCR‐mediated TCA through sEVs or sEV‐carried immune checkpoints. In addition, our clinical data suggest that sEV‐associated PD‐L1 may be not only useful in predicting the outcomes from WJMSC clinical administration, but also in developing cell‐independent therapy for aGvHD patients.
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Affiliation(s)
- Meizhang Li
- Department of Pathology and Laboratory Medicine University of Kansas Medical Center Kansas City Kansas USA
| | - Rupal Soder
- Midwest Stem Cell Therapy Center University of Kansas Medical Center Kansas City Kansas USA
| | - Sunil Abhyankar
- Midwest Stem Cell Therapy Center University of Kansas Medical Center Kansas City Kansas USA.,Division of Hematologic Malignancies and Cellular Therapeutics University of Kansas Medical Center Kansas City Kansas USA.,The University of Kansas Cancer Center, University of Kansas Medical Center Kansas City Kansas USA
| | - Haitham Abdelhakim
- Division of Hematologic Malignancies and Cellular Therapeutics University of Kansas Medical Center Kansas City Kansas USA
| | - Mitchell W Braun
- Department of Pathology and Laboratory Medicine University of Kansas Medical Center Kansas City Kansas USA
| | - Camille V Trinidad
- Department of Microbiology Molecular Genetics and Immunology Kansas City Kansas USA
| | - Harsh B Pathak
- Department of Pathology and Laboratory Medicine University of Kansas Medical Center Kansas City Kansas USA.,The University of Kansas Cancer Center, University of Kansas Medical Center Kansas City Kansas USA
| | - Ziyan Pessetto
- Department of Pathology and Laboratory Medicine University of Kansas Medical Center Kansas City Kansas USA
| | | | - Siddhartha Ganguly
- Division of Hematologic Malignancies and Cellular Therapeutics University of Kansas Medical Center Kansas City Kansas USA
| | - Buddhadeb Dawn
- Midwest Stem Cell Therapy Center University of Kansas Medical Center Kansas City Kansas USA.,Department of Medicine University of Nevada Las Vegas Nevada USA
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics University of Kansas Medical Center Kansas City Kansas USA.,The University of Kansas Cancer Center, University of Kansas Medical Center Kansas City Kansas USA
| | - Neil Dunavin
- Division of Hematologic Malignancies and Cellular Therapeutics University of Kansas Medical Center Kansas City Kansas USA.,Division of Hematology and Blood and Marrow Transplant University of California San Francisco San Francisco California USA
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine University of Kansas Medical Center Kansas City Kansas USA.,The University of Kansas Cancer Center, University of Kansas Medical Center Kansas City Kansas USA.,Department of Microbiology Molecular Genetics and Immunology Kansas City Kansas USA
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16
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Kuravi S, Cheng J, Fangman G, Polireddy K, McCormick S, Lin TL, Singh AK, Abhyankar S, Ganguly S, Welch DR, Jensen RA, McGuirk JP, Balusu R. Preclinical Evaluation of Gilteritinib on NPM1-ALK-Driven Anaplastic Large Cell Lymphoma Cells. Mol Cancer Res 2021; 19:913-920. [PMID: 33514657 DOI: 10.1158/1541-7786.mcr-20-0738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
Anaplastic large cell lymphoma (ALCL) is an aggressive type of non-Hodgkin lymphoma. More than three-fourths of anaplastic lymphoma kinase (ALK)-positive ALCL cases express the nucleophosmin 1 (NPM1)-ALK fusion gene as a result of t(2;5) chromosomal translocation. The homodimerization of NPM1-ALK fusion protein mediates constitutive activation of the chimeric tyrosine kinase activity and downstream signaling pathways responsible for lymphoma cell proliferation and survival. Gilteritinib is a tyrosine kinase inhibitor recently approved by the FDA for the treatment of FMS-like tyrosine kinase mutation-positive acute myeloid leukemia. In this study, we demonstrate for the first time gilteritinib-mediated growth inhibitory effects on NPM1-ALK-driven ALCL cells. We utilized a total of five ALCL model cell lines, including both human and murine. Gilteritinib treatment inhibits NPM1-ALK fusion kinase phosphorylation and downstream signaling, resulting in induced apoptosis. Gilteritinib-mediated apoptosis was associated with caspase 3/9, PARP cleavage, the increased expression of proapoptotic protein BAD, and decreased expression of antiapoptotic proteins, survivin and MCL-1. We also found downregulation of fusion kinase activity resulted in decreased c-Myc protein levels. Furthermore, cell-cycle analysis indicated gilteritinib induced G0-G1-phase cell-cycle arrest and reduced CD30 expression. In summary, our preclinical studies explored the novel therapeutic potential of gilteritinib in the treatment of ALCL cells expressing NPM1-ALK and potentially in other ALK or ALK fusion-driven hematologic or solid malignancies. IMPLICATIONS: Our preclinical results explore the use of gilteritinib for the treatment of NPM1-ALK-driven ALCL cells and pave a path for developing future clinical trials. VISUAL OVERVIEW: http://mcr.aacrjournals.org/content/molcanres/19/5/913/F1.large.jpg.
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Affiliation(s)
- Sudhakiranmayi Kuravi
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Janice Cheng
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Kishore Polireddy
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas
| | - Sophia McCormick
- Biospecimen Repository Core Facility, University of Kansas Medical Center, Kansas City, Kansas
| | - Tara L Lin
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
- The University of Kansas Cancer Center, Kansas City, Kansas
| | - Anurag K Singh
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
- The University of Kansas Cancer Center, Kansas City, Kansas
| | - Sunil Abhyankar
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
- The University of Kansas Cancer Center, Kansas City, Kansas
| | - Siddhartha Ganguly
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
- The University of Kansas Cancer Center, Kansas City, Kansas
| | - Danny R Welch
- The University of Kansas Cancer Center, Kansas City, Kansas
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, Kansas
| | - Roy A Jensen
- The University of Kansas Cancer Center, Kansas City, Kansas
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Joseph P McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
- The University of Kansas Cancer Center, Kansas City, Kansas
| | - Ramesh Balusu
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
- The University of Kansas Cancer Center, Kansas City, Kansas
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17
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Abdelhakim H, Accurso A, Merkel D, Dejarnette S, Aljitawi O, Yankee T, He J, Ganguly S, McGuirk J, Abhyankar S. Peri-transplant extracorporeal photopheresis to mitigate GVHD- a pilot clinical trial. Bone Marrow Transplant 2020; 56:980-982. [PMID: 33219342 DOI: 10.1038/s41409-020-01142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/16/2020] [Accepted: 11/06/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Haitham Abdelhakim
- Division of Hematological Malignancies and Cellular Therapy, University of Kansas Medical Center, Kansas City, KS, USA.,University of Kansas Cancer Center, Kansas City, KS, USA
| | - Anthony Accurso
- Dreiling/Schmidt Cancer Institute, University of Kansas Health System, Hays, KS, USA
| | - Dean Merkel
- Division of Hematological Malignancies and Cellular Therapy, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shaun Dejarnette
- Division of Hematological Malignancies and Cellular Therapy, University of Kansas Medical Center, Kansas City, KS, USA
| | - Omar Aljitawi
- Division of Hematology and Bone Marrow Transplantation, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas Yankee
- Department of Microbiology, Molecular Genetics & Immunology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jianghua He
- Department of Biostatistics & Data Science, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Siddhartha Ganguly
- Division of Hematological Malignancies and Cellular Therapy, University of Kansas Medical Center, Kansas City, KS, USA.,University of Kansas Cancer Center, Kansas City, KS, USA
| | - Joseph McGuirk
- Division of Hematological Malignancies and Cellular Therapy, University of Kansas Medical Center, Kansas City, KS, USA.,University of Kansas Cancer Center, Kansas City, KS, USA
| | - Sunil Abhyankar
- Division of Hematological Malignancies and Cellular Therapy, University of Kansas Medical Center, Kansas City, KS, USA. .,University of Kansas Cancer Center, Kansas City, KS, USA.
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18
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Gao L, Saeed A, Golem S, Zhang D, Woodroof J, McGuirk J, Ganguly S, Abhyankar S, Lin TL, Cui W. High-level MYC expression associates with poor survival in patients with acute myeloid leukemia and collaborates with overexpressed p53 in leukemic transformation in patients with myelodysplastic syndrome. Int J Lab Hematol 2020; 43:99-109. [PMID: 32812335 DOI: 10.1111/ijlh.13316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/02/2020] [Accepted: 07/29/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Patients with mutated and overexpressed p53 have an aggressive course in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Studies on the impact of MYC expression in AML are limited. This is the first study to evaluate MYC expression and p53 status in AML and MDS. METHODS We identified 214 patients, 101 AML, 79 MDS, and 34 negative control patients. We retrospectively assessed p53 and MYC expression by immunohistochemistry and correlated MYC expression with p53 expression and aberrational status of TP53. RESULTS The level of both p53 and MYC expression was significantly higher in AML (mean: 9.7%; 12.1%) and MDS (mean: 5.2%; 5.5%) patients compared with control cases (mean: 0.18%; 2.3%; P = .001-0.02). p53 and MYC expression levels were even more elevated in AML when compared to MDS patients (P < .001). MYC expression was significantly associated with p53 expression and TP53 aberration in AML patients but not in MDS patients (P < .001). p53 expression and >20% MYC expression showed an adverse impact on overall survival (OS) (P < .05) in AML patients while p53 but not MYC expression showed an adverse impact on OS in MDS patients. MYC and p53 dual expression, as well as combined MYC expression and TP53 aberration, showed negative impact on OS in AML patients. MDS patients with leukemic transformation revealed an interval increase in expression of both p53 and MYC. CONCLUSION High-level MYC expression associates with p53 abnormality and poor survival in AML. MYC may provide proliferative advantage for leukemic progression in p53 dependent and independent manner.
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Affiliation(s)
- Linlin Gao
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Azhar Saeed
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shivani Golem
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Da Zhang
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Janet Woodroof
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Siddhartha Ganguly
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sunil Abhyankar
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Tara L Lin
- Division of Hematologic Malignancies and Cellular Therapeutics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Wei Cui
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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19
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Britt A, Mohyuddin GR, McClune B, Singh A, Lin T, Ganguly S, Abhyankar S, Shune L, McGuirk J, Skikne B, Godwin A, Pessetto Z, Golem S, Divine C, Dias A. Acute myeloid leukemia or myelodysplastic syndrome with chromosome 17 abnormalities and long-term outcomes with or without hematopoietic stem cell transplantation. Leuk Res 2020; 95:106402. [PMID: 32590108 DOI: 10.1016/j.leukres.2020.106402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/18/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Chromosome 17 abnormalities, especially disorders of the 17p region and including TP53 gene mutations, result in very low rates of cure for patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) treated with conventional chemotherapy or allogeneic hematopoietic cell transplant (allo-HCT). Our retrospective study analyzed outcomes in patients with chromosome 17 (ch17) abnormalities who received conventional chemotherapy followed by allo-HCT versus those who did not receive a transplant. We analyzed whether poor outcomes extend to patients with all types of ch17 abnormalities and the impact of concomitant TP53 gene mutations assessed by next-generation sequencing (NGS) on prognosis. METHODS We retrospectively analyzed diagnostic and outcome data on 98 patients treated at our institution from 2012 to 2018 with AML or MDS who possessed ch17 abnormalities by cytogenetic analysis. The presence of TP53 mutations was analyzed by NGS. Primary endpoint of our study was overall survival (OS). RESULTS 61 patients with AML and 37 with MDS were included. Complete remission (CR) with first line treatment was similar between induction chemotherapy or hypomethylating agents (HMA), 22.9 % versus 21.6 % (p = 0.33). Median OS for all patients (with or without transplant) was 10 months. Patients with abnormal ch17 in conjunction with any TP53 mutation(s) exhibited worse OS compared to patients without a TP53 mutation (10 versus 23 months, p = 0.02). 30 patients (19 AML, 11 MDS) underwent HCT, with a median OS of 11 months. For AML patients who underwent allo-HCT, 18 were in CR (13 with cytogenetic remission) and 1 had persistent disease at transplant. In the MDS cohort, 3 patients were in CR (2 with cytogenetic remission) and 8 had stable disease. Post allo-HCT survival of AML and MDS cohorts did not differ (p = 0.6), although cytogenetic CR at time of HCT trended towards improved OS (17 versus 8 months; p = 0.6). CONCLUSIONS AML/MDS patients with ch17 abnormalities have poor outcomes with or without HCT. Our results show that patients with ch17 abnormalities and TP53 mutations have a significantly poorer survival compared to patients who have ch17 abnormalities but no TP53 mutations. Drugs targeting abnormalities of the p53 pathway, improvement in depth of response prior to HCT, and novel maintenance strategies are needed for improved outcomes in these patients.
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Affiliation(s)
- Alec Britt
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Ghulam Rehman Mohyuddin
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States.
| | - Brian McClune
- Huntsman Cancer Center, Division of Hematology, University of Utah, United States
| | - Anurag Singh
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Tara Lin
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States; University of Kansas Medical Center, Department of Pathology, United States
| | - Siddhartha Ganguly
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Sunil Abhyankar
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Leyla Shune
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Joseph McGuirk
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Barry Skikne
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Andrew Godwin
- University of Kansas Medical Center, Department of Pathology, United States
| | - Ziyan Pessetto
- University of Kansas Medical Center, Department of Pathology, United States
| | - Shivani Golem
- University of Kansas Medical Center, Department of Pathology, United States
| | - Clint Divine
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, United States
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20
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Soder R, Youngblood S, Yaing R, Lamb L, DiStasi A, Abhyankar S. Point-of care process transfer for GMP-grade manufacturing of ex-vivo expanded and activated γδ T Cells (EAGD) following haploidentical bone marrow transplantation and post-BMT cyclophosphamide. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.305] [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: 11/26/2022]
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21
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Soder R, Abhyankar S, Morrison M, Weir S, Mitchell J, Dunavin N, Li M, Shune L, Singh A, Ganguly S, Dawn B, McGuirk J. A phase i study to evaluate the safety of wharton's jelly mesenchymal stem cells for the treatment of de novo high risk or steroid refractory acute Graft Versus Host Disease (aGVHD). Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.188] [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: 11/26/2022]
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22
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Britt A, Sethpati VR, McGuirk JP, Abhyankar S, Singh AK, Shune L, Lin T, Phadnis M, Cui W, Ganguly S. An Exploratory Trial to Estimate the Proportion of Patients with Tumor Cell Contaminated, Flow Positive Leukapheresis Products Collected with and without Bortezomib As in-Vivo Purging Prior to Autologous Stem Cell Harvest for Multiple Myeloma. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.465] [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: 11/16/2022]
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23
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Sebghati ZJ, Abbasi S, Abhyankar S, Ganguly S, Shune L, McGuirk JP, Singh AK. Endothelial Activation and Stress Index (EASIX) Score at 100 Days Post-allo HCT in Patients with Acute Myeloid Leukemia Predicts Overall Survival. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Morey C, Urbina M, Ganguly S, McGuirk JP, Abhyankar S, Singh AK, Lin T, Shune L. Risk Factors, Incidence, and Outcomes of Cardiac Arrhythmia Among Autologous Stem Cell Transplant Recipients. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Gyurkocza B, Nath R, Stiff PJ, Agura E, Litzow MR, Tomlinson B, Choe H, Abhyankar S, Seropian SE, Chen GL, Hari P, Al-Kadhimi Z, Foran J, Orozco JJ, van Besien K, Sabloff M, Kebriaei P, Abboud C, Levy MY, Lazarus HM, Giralt SA, Berger MS, Reddy V, Pagel JM. Targeted Conditioning with Anti-CD45 Iodine (131I) Apamistamab [Iomab-B] Leads to High Rates of Allogeneic Transplantation and Successful Engraftment in Older Patients with Active, Relapsed or Refractory (rel/ref) AML after Failure of Chemotherapy and Targeted Agents: Preliminary Midpoint Results from the Prospective, Randomized Phase 3 Sierra Trial. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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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26
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Leal J, Rodriguez L, DeJarnette S, Ganguly S, McGuirk JP, Abhyankar S, Shune L, Singh AK. Incorporating Frailty Testing As Part of Pre-Transplant Evaluation for Allogeneic Stem Cell Transplant: Challenges and Future Direction. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Abbasi S, Sebghati ZJ, Abhyankar S, Ganguly S, Shune L, McGuirk JP, Singh AK. Type of Donor in the Setting of Allogeneic Stem Cell Transplant Does Not Significantly Affect Overall Survival in Patients with Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Balmaceda N, Mouw T, Abhyankar S, Male H, Woodroof J, Williamson S, Baranda J. Hematologic malignancies in temozolomide-treated metastatic pancreatic neuroendocrine tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz256.019] [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: 11/12/2022] Open
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29
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Mohyuddin GR, Roller J, Shune L, Lin T, Dias A, Ganguly S, Abhyankar S, McGuirk J, Singh A. Epstein-Barr viremia and post-transplant lymphoproliferative disorders in patients undergoing haploidentical stem cell transplantation with post-transplant cyclophosphamide. Hematol Oncol Stem Cell Ther 2019; 12:171-173. [DOI: 10.1016/j.hemonc.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/03/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022] Open
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Bastidas A, de la Serna J, El Idrissi M, Oostvogels L, Quittet P, López-Jiménez J, Vural F, Pohlreich D, Zuckerman T, Issa NC, Gaidano G, Lee JJ, Abhyankar S, Solano C, Perez de Oteyza J, Satlin MJ, Schwartz S, Campins M, Rocci A, Vallejo Llamas C, Lee DG, Tan SM, Johnston AM, Grigg A, Boeckh MJ, Campora L, Lopez-Fauqued M, Heineman TC, Stadtmauer EA, Sullivan KM. Effect of Recombinant Zoster Vaccine on Incidence of Herpes Zoster After Autologous Stem Cell Transplantation: A Randomized Clinical Trial. JAMA 2019; 322:123-133. [PMID: 31287523 PMCID: PMC6618796 DOI: 10.1001/jama.2019.9053] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Herpes zoster, a frequent complication following autologous hematopoietic stem cell transplantation (HSCT), is associated with significant morbidity. A nonlive adjuvanted recombinant zoster vaccine has been developed to prevent posttransplantation zoster. OBJECTIVE To assess the efficacy and adverse event profile of the recombinant zoster vaccine in immunocompromised autologous HSCT recipients. DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, observer-blinded study conducted in 167 centers in 28 countries between July 13, 2012, and February 1, 2017, among 1846 patients aged 18 years or older who had undergone recent autologous HSCT. INTERVENTIONS Participants were randomized to receive 2 doses of either recombinant zoster vaccine (n = 922) or placebo (n = 924) administered into the deltoid muscle; the first dose was given 50 to 70 days after transplantation and the second dose 1 to 2 months thereafter. MAIN OUTCOMES AND MEASURES The primary end point was occurrence of confirmed herpes zoster cases. RESULTS Among 1846 autologous HSCT recipients (mean age, 55 years; 688 [37%] women) who received 1 vaccine or placebo dose, 1735 (94%) received a second dose and 1366 (74%) completed the study. During the 21-month median follow-up, at least 1 herpes zoster episode was confirmed in 49 vaccine and 135 placebo recipients (incidence, 30 and 94 per 1000 person-years, respectively), an incidence rate ratio (IRR) of 0.32 (95% CI, 0.22-0.44; P < .001), equivalent to 68.2% vaccine efficacy. Of 8 secondary end points, 3 showed significant reductions in incidence of postherpetic neuralgia (vaccine, n=1; placebo, n=9; IRR, 0.1; 95% CI, 0.00-0.78; P = .02) and of other prespecified herpes zoster-related complications (vaccine, n=3; placebo, n=13; IRR, 0.22; 95% CI, 0.04-0.81; P = .02) and in duration of severe worst herpes zoster-associated pain (vaccine, 892.0 days; placebo, 6275.0 days; hazard ratio, 0.62; 95% CI, 0.42-0.89; P = .01). Five secondary objectives were descriptive. Injection site reactions were recorded in 86% of vaccine and 10% of placebo recipients, of which pain was the most common, occurring in 84% of vaccine recipients (grade 3: 11%). Unsolicited and serious adverse events, potentially immune-mediated diseases, and underlying disease relapses were similar between groups at all time points. CONCLUSIONS AND RELEVANCE Among adults who had undergone autologous HSCT, a 2-dose course of recombinant zoster vaccine compared with placebo significantly reduced the incidence of herpes zoster over a median follow-up of 21 months. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01610414.
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Affiliation(s)
| | | | | | | | | | | | - Filiz Vural
- Ege University Medical School, Izmir, Turkey
| | | | | | - Nicolas C. Issa
- Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gianluca Gaidano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Je-Jung Lee
- Chonnam National University Hwasun Hospital, Jellanamdo, Republic of Korea
| | | | - Carlos Solano
- Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain
| | - Jaime Perez de Oteyza
- Centro Integral Oncológico Clara Campal (CIOCC), Universidad CEU San Pablo, Madrid, Spain
| | | | - Stefan Schwartz
- Department of Hematology and Oncology, Charité University Medical Center, Berlin, Germany
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Alberto Rocci
- Haematology Department, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, England
- Faculty of Biology, Medicine and Health, School of Medical Science, Division of Cancer Sciences, University of Manchester, Manchester, England
| | | | - Dong-Gun Lee
- Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | | | | | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, Australia
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Brownback KR, Frey JW, Abhyankar S. Bronchoscopic features, associations, and outcomes of organizing pneumonia following allogeneic hematopoietic stem cell transplantation. Ann Hematol 2019; 98:2187-2195. [PMID: 31273420 PMCID: PMC7080065 DOI: 10.1007/s00277-019-03746-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/15/2019] [Indexed: 12/22/2022]
Abstract
Organizing pneumonia (OP) is a poorly understood complication of hematopoietic stem cell transplant (HSCT). We identified 15 patients diagnosed with OP following HSCT and described their clinical course. CT chest findings were remarkable for multifocal infiltrates that were predominantly consolidating or ground glass opacities. Bronchoalveolar lavage (BAL) was performed on 14 patients with five having lymphocytosis (> 25% lymphocytes), three with eosinophilia (> 5% eosinophils), three with neutrophilia (> 30% neutrophils), and three with normal cell counts. Flow cytometry was analyzed on BAL fluid in 13 patients with 11 having a CD4/CD8 of < 0.9. Initial treatment with 0.3–1.0 mg/kg prednisone resulted in improvement in symptoms, in radiographic findings, and in pulmonary function testing for the majority of patients. Six patients had recurrence of OP after completing treatment. Eleven patients had evidence of extra-pulmonary graft-versus-host disease prior to diagnosis of OP, and seven patients were diagnosed with an upper respiratory tract infection (URI) within 8 weeks of OP diagnosis. Most patients respond well to prednisone with significant improvement in pulmonary function, but risk of recurrence is high after cessation of steroid treatment. Risk factors for the development of OP may include prior URI.
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Affiliation(s)
- Kyle R Brownback
- Division of Pulmonary and Critical Care Medicine, University of Kansas School of Medicine, Kansas City, KS, USA. .,Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, 3901 Rainbow BLVD, Mail stop #3007, Kansas City, KS, 66160, USA.
| | - John W Frey
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Sunil Abhyankar
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas School of Medicine, Kansas City, KS, USA
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Gacio GG, Eguiluz CC, Naranjo ML, Baldrich MB, Naque MR, Mota AM, Abhyankar S. Adoption of clinical vocabularies LOINC® and SNOMED CT® in the microbiology laboratory and their integration in the information systems and electronic medical records. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wieliczka ML, Fitzmaurice S, Merkel D, Shune L, McClune B, Ganguly S, McGuirk J, Abhyankar S. Optimizing the Use of Plerixafor for Stem Cell Collection (SCC) for Autologous Stem Cell Transplant (ASCT) and Developing an Algorithm. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bolaños-Meade J, Reshef R, Fraser R, Fei M, Abhyankar S, Al-Kadhimi Z, Alousi AM, Antin JH, Arai S, Bickett K, Chen YB, Damon LE, Efebera YA, Geller NL, Giralt SA, Hari P, Holtan SG, Horowitz MM, Jacobsohn DA, Jones RJ, Liesveld JL, Logan BR, MacMillan ML, Mielcarek M, Noel P, Pidala J, Porter DL, Pusic I, Sobecks R, Solomon SR, Weisdorf DJ, Wu J, Pasquini MC, Koreth J. Three prophylaxis regimens (tacrolimus, mycophenolate mofetil, and cyclophosphamide; tacrolimus, methotrexate, and bortezomib; or tacrolimus, methotrexate, and maraviroc) versus tacrolimus and methotrexate for prevention of graft-versus-host disease with haemopoietic cell transplantation with reduced-intensity conditioning: a randomised phase 2 trial with a non-randomised contemporaneous control group (BMT CTN 1203). Lancet Haematol 2019; 6:e132-e143. [PMID: 30824040 PMCID: PMC6503965 DOI: 10.1016/s2352-3026(18)30221-7] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prevention of graft-versus-host disease (GvHD) without malignant relapse is the overall goal of allogeneic haemopoietic cell transplantation (HCT). We aimed to evaluate regimens using either maraviroc, bortezomib, or post-transplantation cyclophosphamide for GvHD prophylaxis compared with controls receiving the combination of tacrolimus and methotrexate using a novel composite primary endpoint to identify the most promising intervention to be further tested in a phase 3 trial. METHODS In this prospective multicentre phase 2 trial, adult patients aged 18-75 years who received reduced-intensity conditioning HCT were randomly assigned (1:1:1) by random block sizes to tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide (cyclophosphamide 50 mg/kg on days 3 and 4, followed by tacrolimus starting on day 5 and mycophenolate mofetil starting on day 5 at 15 mg/kg three times daily not to exceed 1 g from day 5 to day 35); tacrolimus, methotrexate, and bortezomib (bortezomib 1·3 mg/m2 intravenously on days 1, 4, and 7 after HCT); or tacrolimus, methotrexate, and maraviroc (maraviroc 300 mg orally twice daily from day -3 to day 30 after HCT). Methotrexate was administered as a 15 mg/m2 intravenous bolus on day 1 and 10 mg/m2 intravenous bolus on days 3, 6, and 11 after HCT; tacrolimus was given intravenously at a dose of 0·05 mg/kg twice daily (or oral equivalent) starting on day -3 (except the post-transplantation cyclophosphamide, as indicated), with a target level of 5-15 ng/mL. Tacrolimus was continued at least until day 90 and was tapered off by day 180. Each study group was compared separately to a contemporary non-randomised prospective cohort of patients (control group) who fulfilled the same eligibility criteria as the trial, but who were treated with tacrolimus and methotrexate at centres not participating in the trial. The primary endpoint (GvHD-free, relapse-free survival [GRFS]) was defined as the time from HCT to onset of grade 3-4 acute GvHD, chronic GvHD requiring systemic immunosuppression, disease relapse, or death. The study was analysed by modified intention to treat. The study is closed to accrual and this is the planned analysis. This trial is registered with ClinicalTrials.gov, number NCT02208037. FINDINGS Between Nov 17, 2014, and May 18, 2016, 273 patients from 31 US centres were randomly assigned to the three study arms: 89 to tacrolimus, methotrexate, and bortezomib; 92 to tacrolimus, methotrexate, and maraviroc; 92 to tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; and six were excluded. Between Aug 1, 2014, and Sept 14, 2016, 224 controls received tacrolimus and methotrexate. Controls were generally well matched except for more frequent comorbidities than the intervention groups and a different distribution of types of conditioning regimens used. Compared with controls, the hazard ratio for GRFS was 0·72 (90% CI 0·54-0·94; p=0·044) for tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide, 0·98 (0·76-1·27; p=0·92) for tacrolimus, methotrexate, and bortezomib, and 1·10 (0·86-1·41; p=0·49) for tacrolimus, methotrexate, and maraviroc. 238 patients experienced grade 3 or 4 toxicities: 12 (13%) had grade 3 and 67 (73%) grade 4 events with tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; ten (11%) had grade 3 and 68 (76%) had grade 4 events with tacrolimus, methotrexate, and bortezomib; and 18 (20%) had grade 3 and 63 (68%) had grade 4 events with tacrolimus, methotrexate, and maraviroc. The most common toxicities were haematological (77 [84%] for tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; 73 [82%] for tacrolimus, methotrexate, and bortezomib; and 78 [85%] for tacrolimus, methotrexate, and maraviroc) and cardiac (43 [47%], 44 [49%], and 43 [47%], respectively). INTERPRETATION Tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide was the most promising intervention, yielding the best GRFS; this regimen is thus being prospectively compared with tacrolimus and methotrexate in a phase 3 randomised trial. FUNDING US National Health, Lung, and Blood Institute; National Cancer Institute; National Institute of Allergy and Infectious Disease; and Millennium Pharmaceuticals.
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Affiliation(s)
- Javier Bolaños-Meade
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
| | - Ran Reshef
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Raphael Fraser
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mingwei Fei
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sunil Abhyankar
- Department of Internal Medicine, University of Kansas Medical Center, Westwood, KS, USA
| | - Zaid Al-Kadhimi
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Amin M Alousi
- Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph H Antin
- Department of Medicial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sally Arai
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | | | - Yi-Bin Chen
- Department of Medicine, Massachusetts General, Hospital, Boston, MA, USA
| | - Lloyd E Damon
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yvonne A Efebera
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Nancy L Geller
- Office of Biostatistics Research, National Institutes of Health, Bethesda, MD, USA
| | - Sergio A Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Parameswaran Hari
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shernan G Holtan
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Mary M Horowitz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David A Jacobsohn
- Department of Pediatrics at George Washington University, Children's National Medical Center, Washington, DC, USA
| | - Richard J Jones
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Jane L Liesveld
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Brent R Logan
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Marco Mielcarek
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Pierre Noel
- Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Joseph Pidala
- Blood and Marrow Transplantation and Cellular Immunotherapy, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - David L Porter
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Iskra Pusic
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ronald Sobecks
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R Solomon
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Daniel J Weisdorf
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Juan Wu
- The Emmes Corporation, Rockville, MD, USA
| | - Marcelo C Pasquini
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Koreth
- Department of Medicial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Balmaceda N, Abhyankar S, Mouw T, Baranda J. Abstract 599: Secondary malignancies in temozolomide-treated metastatic pancreatic neuroendocrine tumors. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-599] [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: 11/16/2022]
Abstract
Abstract
Purpose: To determine the incidence of secondary malignancies in patients treated with temozolomide (TMZ) for metastatic pancreatic neuroendocrine tumors (PNET).
Background: TMZ is an oral alkylating agent used to treat glioblastoma multiforme (GBM), refractory anaplastic astrocytoma (AA), and metastatic PNET. This imidazotetrazine analog of dacarbazine lacks the ability to directly crosslink DNA and is thought to be less leukemogenic than other alkylators. Given either alone, or in combination with other therapies, TMZ is associated with improved clinical outcomes. However, serious hematologic adverse events (HAEs) like agranulocytosis, lymphopenia and aplastic anemia are not uncommon. Until recently, metastatic PNET was primarily managed with somatostatin-analogs, but with more reports demonstrating therapeutic activity of TMZ-based regimens, it is anticipated that more patients with metastatic PNET will be exposed to TMZ.
Methods: To determine the incidence of secondary malignancy in TMZ-treated PNET, a systematic review of all known clinical trials, case reports, and other relevant literature regarding PNET and TMZ published before September 2017 was conducted using PubMed, Embase, Cochrane Library, and the FDA database.
Results: Twenty-one publications, including clinical trials, meta-analyses, case reports, and cohort studies were analyzed. HAEs ranged from agranulocytosis to myelodysplastic syndrome. No publications reported any secondary malignancies. Incidentally, at the University of Kansas Medical Center, 3 patients with TMZ-treated PNET developed hematologic malignancies. A 29-year-old female with metastatic PNET was treated with TMZ and subsequently developed acute myeloid leukemia (AML) with cytogenetics consistent with therapy-related leukemia. The second patient with TMZ-treated metastatic PNET developed diffuse large B-cell lymphoma. These two patients both had aggressive disease that was not responsive to multiple rounds of treatment. They succumbed to their hematologic malignancy, and not from metastatic PNET. The third patient is a 29-year-old who was recently diagnosed with high-grade T-cell lymphoblastic lymphoma and is currently undergoing treatment for his lymphoma.
Conclusion: This review did not find any cases of secondary malignancy in TMZ-treated metastatic PNET. Yet, at our own institution we have identified 3 cases of secondary hematologic malignancies in patients treated with TMZ for PNET. We believe that the leukemogenic potential of TMZ is underreported and anticipate increased reports of secondary malignancy as the use of TMZ increases. It is important for treatment guidelines to address this risk in the decision to pursue TMZ treatment. Appropriate dosing, proper follow-up and surveillance, especially in patients who are able to live long enough to develop these hematologic cancers, is crucial.
Citation Format: Nicole Balmaceda, Sunil Abhyankar, Tyler Mouw, Joaquina Baranda. Secondary malignancies in temozolomide-treated metastatic pancreatic neuroendocrine tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 599.
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Affiliation(s)
| | | | - Tyler Mouw
- 2University of Kansas Medical Center, Kansas City, KS
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Carpenter PA, Logan BR, Lee SJ, Weisdorf DJ, Johnston L, Costa LJ, Kitko CL, Bolaños-Meade J, Sarantopoulos S, Alousi AM, Abhyankar S, Waller EK, Mendizabal A, Zhu J, O'Brien KA, Lazaryan A, Wu J, Nemecek ER, Pavletic SZ, Cutler CS, Horowitz MM, Arora M. A phase II/III randomized, multicenter trial of prednisone/sirolimus versus prednisone/ sirolimus/calcineurin inhibitor for the treatment of chronic graft- versus-host disease: BMT CTN 0801. Haematologica 2018; 103:1915-1924. [PMID: 29954931 PMCID: PMC6278959 DOI: 10.3324/haematol.2018.195123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/26/2018] [Indexed: 12/17/2022] Open
Abstract
Initial therapy of chronic graft-versus-host disease is prednisone ± a calcineurin-inhibitor, but most patients respond inadequately. In a randomized, adaptive, phase II/III, multicenter trial we studied whether prednisone/sirolimus or prednisone/sirolimus/photopheresis was more effective than prednisone/sirolimus/calcineurin-inhibitor for treating chronic graft-versus-host disease in treatment-naïve or early inadequate responders. Primary endpoints of this study were proportions of subjects alive without relapse or secondary therapy with 6-month complete or partial response in phase II, or with 2-year complete response in phase III. The prednisone/sirolimus/photopheresis arm closed prematurely because of slow accrual and the remaining two-drug versus three-drug study ended in phase II due to statistical futility with 138 evaluable subjects. The two-drug and three-drug arms did not differ in rates of 6-month complete or partial response (48.6% versus 50.0%, P=0.87), or 2-year complete response (14.7% versus 15.5%, P=0.90). Serum creatinine values >1.5 times baseline were less frequent in the calcineurin-inhibitor-free arm at 2 months (1.5% versus 11.7%, P=0.025) and 6 months (7.8% versus 24.0%, P=0.016). Higher adjusted Short Form-36 Physical Component Summary and Physical Functioning scores were seen in the two-drug arm at both 2 months (P=0.02 and P=0.04, respectively) and 6 months (P=0.007 and P=0.001, respectively). Failure-free survival and overall survival rates at 2 years were similar for patients in the the two-drug and three-drug arms (48.6% versus 46.2%, P=0.78; 81.5% versus 74%, P=0.28). Based on similar long-term outcomes, prednisone/sirolimus is a therapeutic alternative to prednisone/sirolimus/calcineurin-inhibitor for chronic graft-versus-host disease, being easier to administer and better tolerated. Clinicaltrials.gov identifier: NCT01106833.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amin M Alousi
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Jiaxi Zhu
- The Emmes Corporation, Rockville, MD
| | | | | | - Juan Wu
- The Emmes Corporation, Rockville, MD
| | | | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD
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Prohaska L, Mahmoudjafari Z, Shune L, Singh A, Lin T, Abhyankar S, Ganguly S, Grauer D, McGuirk J, Clough L. Retrospective evaluation of fidaxomicin versus oral vancomycin for treatment of Clostridium difficile infections in allogeneic stem cell transplant. Hematol Oncol Stem Cell Ther 2018; 11:233-240. [PMID: 29928848 DOI: 10.1016/j.hemonc.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/17/2018] [Accepted: 05/12/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE/BACKGROUND Clostridium difficile infection (CDI) is a potential complication during hematopoietic stem cell transplantation (HSCT), and no specific recommendations exist regarding treatment of CDI in allogeneic SCT patients. Use of metronidazole and oral vancomycin has been associated with clinical failure. Fidaxomicin has previously been found noninferior to the use of oral vancomycin for the treatment of CDI, and no studies have compared the use of oral vancomycin with fidaxomicin for the treatment of CDI in allogeneic SCT. METHODS This retrospective chart review included 96 allogeneic SCT recipients who developed CDI within 100 days following transplantation. Participants were treated with oral vancomycin (n = 52) or fidaxomicin (n = 44). The primary outcome was clinical cure, defined as no need for further retreatment 2 days following completion of initial CDI treatment. Secondary outcomes were global cure, treatment failure, and recurrent disease. RESULTS No differences in clinical cure were observed between patients receiving oral vancomycin or fidaxomicin (75% vs. 75%, p = 1.00). Secondary outcomes were similar between oral vancomycin and fidaxomicin in regards to global cure (66% vs. 67%, p = .508), treatment failure (28% vs. 27%, p = .571), and recurrent disease (7% vs. 5%, p = .747). In a subanalysis of individuals that developed acute graft-versus-host disease following CDI, the difference in mean onset of acute graft-versus-host disease was 21.03 days in the oral vancomycin group versus 32.88 days in the fidaxomicin group (p = .0031). CONCLUSION The findings of this study suggest that oral vancomycin and fidaxomicin are comparable options for CDI treatment in allogeneic SCT patients within 100 days following transplant.
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Affiliation(s)
- Laura Prohaska
- Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA.
| | | | - Leyla Shune
- University of Kansas Hospital, Kansas City, KS, USA; University of Kansas School of Medicine, Kansas City, KS, USA
| | - Anurag Singh
- University of Kansas Hospital, Kansas City, KS, USA; University of Kansas School of Medicine, Kansas City, KS, USA
| | - Tara Lin
- University of Kansas Hospital, Kansas City, KS, USA; University of Kansas School of Medicine, Kansas City, KS, USA
| | - Sunil Abhyankar
- University of Kansas Hospital, Kansas City, KS, USA; University of Kansas School of Medicine, Kansas City, KS, USA
| | - Siddhartha Ganguly
- University of Kansas Hospital, Kansas City, KS, USA; University of Kansas School of Medicine, Kansas City, KS, USA
| | - Dennis Grauer
- Department of Pharmacy Practice, University of Kansas School of Pharmacy, Lawrence, KS, USA
| | - Joseph McGuirk
- University of Kansas Hospital, Kansas City, KS, USA; University of Kansas School of Medicine, Kansas City, KS, USA
| | - Lisa Clough
- University of Kansas Hospital, Kansas City, KS, USA; University of Kansas School of Medicine, Kansas City, KS, USA
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Brownback KR, Pitts LR, Abhyankar S. Safety of nintedanib for treatment of fibrotic lung disease after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2018; 53:1218-1220. [PMID: 29700478 DOI: 10.1038/s41409-018-0182-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/25/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Kyle R Brownback
- Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Lucas R Pitts
- Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sunil Abhyankar
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
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Spellecy R, Tarima S, Denzen E, Moore H, Abhyankar S, Dawson P, Foley A, Gersten I, Horwitz M, Idossa L, Joffe S, Kamani N, King R, Lazaryan A, Morris L, Horowitz MM, Majhail NS. Easy-to-Read Informed Consent Form for Hematopoietic Cell Transplantation Clinical Trials: Results from the Blood and Marrow Transplant Clinical Trials Network 1205 Study. Biol Blood Marrow Transplant 2018; 24:2145-2151. [PMID: 29679770 DOI: 10.1016/j.bbmt.2018.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
Because of the complexity of hematopoietic cell transplant trial treatments, informed consent forms are often long and difficult to read. We evaluated a 2-column easy-to-read informed consent (ETRIC) form that incorporates elements of health literacy and readability in participants and centers participating in Blood and Marrow Transplant Clinical Trials Network (BMT CTN) clinical trials. In a randomized study 198 adult patients from 25 centers potentially eligible to participate in 4 BMT CTN interventional trials were randomized to the ETRIC form or a standard consent form for that trial. Both forms were written at no more than an eighth-grade reading level. The primary endpoint was objective comprehension score on the Quality of Informed Consent, part A (QuIC-A) instrument. In a parallel evaluation study, 2 moderators conducted semistructured interviews of 49 investigators, research staff, and institutional review board (IRB) members at 9 BMT CTN trial sites. The mean QuIC-A scores were comparable in 152 patients (77%) assessable for the primary endpoint (ETRIC form, 80.5; standard form, 81.8; P = .37). In regression analysis there was no significant association between the consent type and QuIC-A score. In the evaluation study dominant themes identified on qualitative analyses included general comfort and willingness to use the ETRIC template and that its formatting and layout enhancements would offer additional value to research participants, investigators, and IRBs. IRB language preferences and requirements, length, and prior experience with alternative consent formats were perceived as barriers. Among patients considering participation in BMT CTN clinical trials, the formatting enhancements of the ETRIC form did not alter comprehension of the trial. Despite local challenges to implementation, trial sites generally viewed the ETRIC form favorably and expressed willingness to use it over standard consent form.
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Affiliation(s)
- Ryan Spellecy
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sergey Tarima
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ellen Denzen
- National Marrow Donor Program, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Heather Moore
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Sunil Abhyankar
- Department of Hematologic Malignancies and Cellular Therapies, Kansas University Medical Center, Kansas City, Kansas
| | | | - Amy Foley
- National Marrow Donor Program, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - Mitchell Horwitz
- Department of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Lensa Idossa
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Steven Joffe
- Division of Medical Ethics, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Roberta King
- National Marrow Donor Program, Minneapolis, Minnesota
| | - Aleksandr Lazaryan
- Department of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Lawrence Morris
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Mary M Horowitz
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
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Rodriguez L, Bosak K, Lin TL, Dunavin N, Shune L, Abhyankar S, McGuirk J, Ganguly S. Using Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) Tool to Explore Quality of Life in Patients Undergoing Autologous Stem Cell Transplantation in the Outpatient Setting. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mohyuddin GR, Clark AE, Roller J, Shune L, Lin T, Dunavin N, Dias A, Ganguly S, Abhyankar S, McGuirk J, Singh A. Utility of Routine Surveillance Imaging for Hodgkin Disease following Autologous Transplant: Experiences from a Single Institution. Acta Haematol 2018; 139:52-57. [PMID: 29339629 DOI: 10.1159/000484549] [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: 04/27/2017] [Accepted: 10/24/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surveillance scans performed after autologous stem cell transplant (auto-HCT) for patients with Hodgkin disease (HD) have no proven survival benefit. METHODS We studied survival differences among patients with HD after auto-HCT whose recurrences were detected on clinical history and exam, versus those detected on routine surveillance scan. RESULTS Among the 98 patients with HD that underwent auto-HCT from 2000 to 2014 at our institution, 30 relapsed, of which 21 were detected radiologically and 9 clinically. There were no statistically significant differences in patient characteristics between the 2 groups. The median time to progression was 118 days for the clinical cohort and 284 days for the radiological cohort (p = 0.05). Median overall survival (OS) was 728 days for the clinical cohort, and was not reached for the radiological cohort (p = 0.02). DISCUSSION In our review, most patients with HD after auto-HCT were diagnosed radiologically. Patients whose relapse was diagnosed clinically were likely to be detected earlier and have a shorter OS. Patients with aggressive disease may be detected when clinically relevant, regardless of scanning. Routine scanning may not be necessary in the majority of patients with HD following auto-HCT.
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Affiliation(s)
- Ghulam Rehman Mohyuddin
- Division of Hematologic Malignancies and Cellular Therapeutic (HMCT), University of Kansas Medical Center, Kansas City, KS, USA
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Mohyuddin GR, Clark AE, Roller J, Shune L, Lin T, Dunavin N, Dias A, Ganguly S, Abhyankar S, McGuirk J, Singh A. Utility of routine surveillance imaging for diffuse large B-cell lymphoma post autologous transplant: A single center experience. Hematol Oncol Stem Cell Ther 2017; 11:135-141. [PMID: 29278676 DOI: 10.1016/j.hemonc.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/13/2017] [Accepted: 11/18/2017] [Indexed: 11/29/2022] Open
Abstract
Surveillance scans after autologous stem cell transplant (auto-HCT) for patients with relapsed/refractory (RR) diffuse large B Cell lymphoma (DLBCL) have no proven survival benefit. We studied survival differences among patients with RR DLBCL post auto-HCT whose recurrences were detected clinically versus with routine surveillance imaging. Among the 139 patients with RR DLBCL that underwent auto-HCT from 2000 to 2014 at our institution, 37 relapsed: 21 clinical and 16 radiological. The median time to progression was 167 days for the clinical cohort and 565 days for the radiological cohort (p = 0.03), and median overall survival (OS) was 587 days and not reached, respectively (p = 0.006). Most patients with relapsed DLBCL after auto-HCT were diagnosed clinically and were likely to be detected earlier and have a shorter OS. Relapse in patients with aggressive disease will likely be detected when clinically apparent, and the outcome of these patients is independent of the way the relapse is diagnosed. Thus, universal scanning after auto-HCT appears to have little benefit.
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Affiliation(s)
| | | | | | - Leyla Shune
- Division of Hematologic Malignancies and Cellular Therapeutic (HMCT), University of Kansas Medical Center, USA
| | - Tara Lin
- Division of Hematologic Malignancies and Cellular Therapeutic (HMCT), University of Kansas Medical Center, USA
| | - Neil Dunavin
- Division of Hematologic Malignancies and Cellular Therapeutic (HMCT), University of Kansas Medical Center, USA
| | - Ajoy Dias
- Division of Hematologic Malignancies and Cellular Therapeutic (HMCT), University of Kansas Medical Center, USA
| | - Siddhartha Ganguly
- Division of Hematologic Malignancies and Cellular Therapeutic (HMCT), University of Kansas Medical Center, USA
| | - Sunil Abhyankar
- Division of Hematologic Malignancies and Cellular Therapeutic (HMCT), University of Kansas Medical Center, USA
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutic (HMCT), University of Kansas Medical Center, USA
| | - Anurag Singh
- Division of Hematologic Malignancies and Cellular Therapeutic (HMCT), University of Kansas Medical Center, USA
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Obiozor C, Subramaniam DP, Divine C, Shune L, Singh AK, Lin TL, Abhyankar S, Chen GJ, McGuirk J, Ganguly S. Evaluation of Performance Status and Hematopoietic Cell Transplantation Specific Comorbidity Index on Unplanned Admission Rates in Patients with Multiple Myeloma Undergoing Outpatient Autologous Stem Cell Transplantation. Biol Blood Marrow Transplant 2017; 23:1641-1645. [DOI: 10.1016/j.bbmt.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/02/2017] [Indexed: 11/27/2022]
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McGuirk J, Waller EK, Qayed M, Abhyankar S, Ericson S, Holman P, Keir C, Myers GD. Building blocks for institutional preparation of CTL019 delivery. Cytotherapy 2017; 19:1015-1024. [PMID: 28754600 DOI: 10.1016/j.jcyt.2017.06.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is an investigational immunocellular therapy that reprograms a patient's cytotoxic T cells to engage and eliminate malignant cells. CAR T-cell therapies targeting the CD19 antigen have demonstrated high efficacy in clinical trials for patients with B-cell malignancies and may potentially be available on a broader scale in the future. CAR T-cell therapy begins with the collection of a sufficient number of T cells from a patient's peripheral blood through leukapheresis. Several factors must be considered when patients undergo leukapheresis for CAR T-cell therapy, including age and prior therapies. The leukapheresis material is shipped to a manufacturing facility, followed by return of the CAR T cells to the treatment center. Careful coordination of a multidisciplinary team composed of physicians, nurses, pharmacists and other hospital personnel is critical for the proper care of the patient before, during and after CAR T-cell therapy. CAR T-cell therapy has been associated with adverse events (AEs) such as cytokine release syndrome, which requires rapid attention by the emergency department, intensive care unit and hospital pharmacy. In this review, we discuss several aspects of institutional preparation for leukapheresis, CAR T-cell infusion and AE management based on our experience with clinical trials of the CD19 CAR T-cell therapy CTL019.
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Affiliation(s)
- Joseph McGuirk
- The University of Kansas Medical Center, Kansas City, KS, USA.
| | | | - Muna Qayed
- Emory University School of Medicine, Atlanta, GA, USA
| | - Sunil Abhyankar
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Peter Holman
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - G Douglas Myers
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Bryce AH, Alumkal JJ, Armstrong A, Higano CS, Iversen P, Sternberg CN, Rathkopf D, Loriot Y, de Bono J, Tombal B, Abhyankar S, Lin P, Krivoshik A, Phung D, Beer TM. Radiographic progression with nonrising PSA in metastatic castration-resistant prostate cancer: post hoc analysis of PREVAIL. Prostate Cancer Prostatic Dis 2017; 20:221-227. [PMID: 28117385 PMCID: PMC5435962 DOI: 10.1038/pcan.2016.71] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/08/2016] [Accepted: 11/29/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Advanced prostate cancer is a phenotypically diverse disease that evolves through multiple clinical courses. PSA level is the most widely used parameter for disease monitoring, but it has well-recognized limitations. Unlike in clinical trials, in practice, clinicians may rely on PSA monitoring alone to determine disease status on therapy. This approach has not been adequately tested. METHODS Chemotherapy-naive asymptomatic or mildly symptomatic men (n=872) with metastatic castration-resistant prostate cancer (mCRPC) who were treated with the androgen receptor inhibitor enzalutamide in the PREVAIL study were analyzed post hoc for rising versus nonrising PSA (empirically defined as >1.05 vs ⩽1.05 times the PSA level from 3 months earlier) at the time of radiographic progression. Clinical characteristics and disease outcomes were compared between the rising and nonrising PSA groups. RESULTS Of 265 PREVAIL patients with radiographic progression and evaluable PSA levels on the enzalutamide arm, nearly one-quarter had a nonrising PSA. Median progression-free survival in this cohort was 8.3 months versus 11.1 months in the rising PSA cohort (hazard ratio 1.68; 95% confidence interval 1.26-2.23); overall survival was similar between the two groups, although less than half of patients in either group were still at risk at 24 months. Baseline clinical characteristics of the two groups were similar. CONCLUSIONS Non-rising PSA at radiographic progression is a common phenomenon in mCRPC patients treated with enzalutamide. As restaging in advanced prostate cancer patients is often guided by increases in PSA levels, our results demonstrate that disease progression on enzalutamide can occur without rising PSA levels. Therefore, a disease monitoring strategy that includes imaging not entirely reliant on serial serum PSA measurement may more accurately identify disease progression.
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Affiliation(s)
- A H Bryce
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - J J Alumkal
- OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - A Armstrong
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - C S Higano
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - P Iversen
- Department of Clinical Medicine, Rigshospitalet, Copenhagen, Denmark
| | - C N Sternberg
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - D Rathkopf
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Y Loriot
- Department of Cancer Medicine, Institut Gustave-Roussy, Villejuif, France
| | - J de Bono
- Division of Clinical Studies, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - B Tombal
- Division of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - S Abhyankar
- Medical Affairs, Medivation, Inc., San Francisco, CA, USA
| | - P Lin
- Biostatistics, Medivation, Inc., San Francisco, CA, USA
| | - A Krivoshik
- Medical Oncology, Astellas Pharma, Inc., Northbrook, IL, USA
| | - D Phung
- Biostatistics, Astellas Pharma, Inc., Northbrook, IL, USA
| | - T M Beer
- OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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Yankee T, Dai D, Dalal JD, Hassaballa A, Ganguly S, McGuirk J, Abhyankar S. Using Helper T Cell Function to Predict the Response of Chronic GVHD Patients to ECP Therapy. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abdelhakim H, Bhatti S, Cantilena AR, Lin TL, Ganguly S, Singh AK, Abhyankar S, Lipe B, McGuirk J, Allin D, Shune L, Aljitawi O. Outcomes of Autologous Hematopoietic Cell Transplantation Patients Receiving Hyperbaric Oxygen Therapy. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Obiozor C, Subramaniam D, Chen GJ, Divine CL, Shune L, Singh AK, Lin TL, Abhyankar S, McGuirk J, Ganguly S. Lower Performance Status and Higher Hematopoietic Cell Transplantation Specific Co-Morbidity Index are Associated with Increased Unplanned Admission Rates for Patients with Multiple Myeloma Undergoing Outpatient Autologous Stem Cell Transplantation. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Bryce A, Alumkal J, Armstrong A, Higano C, Iversen P, Sternberg C, Rathkopf D, Loriot Y, de Bono J, Tombal B, Abhyankar S, Lin P, Krivoshik A, Phung D, Beer T. A post hoc analysis of radiographic progression with nonrising prostate-specific antigen in patients with metastatic castration-resistant prostate cancer (mCRPC) in the PREVAIL study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.44] [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: 11/12/2022] Open
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Seremet S, Abhyankar S, Herd TJ, Aires D. 75% Complete Response and 15% Partial Response to Extracorporeal Photopheresis Combined With Other Therapies in Resistant Early Stage Cutaneous T-Cell Lymphoma. J Drugs Dermatol 2016; 15:1212-1216. [PMID: 27741338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Extracorporeal photopheresis (ECP) has been used for the treatment of advanced stage or treatment refractory cutaneous T-cell lymphoma (CTCL) since 1987, and more recently has also been shown to be of benefit for earlier stage resistant CTCL. Complete response rates in prior studies of ECP in early CTCL have ranged from 0% to 40%. METHODS We reviewed electronic medical records of all CTCL patients seen in the University of Kansas Cancer Center between June 2007 and May 2011. International review board approval was obtained. Inclusion criteria were (1) early stage CTCL and (2) ECP treatment. Data included demographics, type of intravenous access employed, CTCL subtype, cytogenetic features, adverse events, adjuvant treatments, and survival time in years. Treatment response was assessed via a modified severity weighted assessment tool (mSWAT). Primary outcome measures were response rates to ECP at 6 months and 12 months after beginning treatment. RESULTS Of 20 patients (13 female; 7 male), 7 were Stage 1A, 11 were 1B, and 2 were 2A. Seven patients with stable disease and 2 patients with progression at 6 months received adjuvant therapy (PUVA/systemic retinoids/metotrexate/interferon) in addition to ECP. Twelve-month response to ECP was 90%: 15 patients (75%) had complete responses, 3 (15%) had partial responses, 1 had stable disease, and 1 progressed. CONCLUSION Used alone or in combination with adjuvant treatments, ECP can be an effective treatment method in early stage CTCL. <br /><br /> <em>J Drugs Dermatol.</em> 2016;15(10):1212-1216.
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