1
|
Golijanin B, Malshy K, Bhatt V, Homer A, Ochsner A, Wales R, Khaleel S, Mega A, Pareek G, Hyams E. Response to shared decision making in prostate cancer screening: Different perspective of public health physicians and urologists. Cancer Epidemiol 2024:102570. [PMID: 38641469 DOI: 10.1016/j.canep.2024.102570] [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: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/21/2024]
Affiliation(s)
- B Golijanin
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - K Malshy
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - V Bhatt
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - A Homer
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - A Ochsner
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - R Wales
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - S Khaleel
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - A Mega
- Lifespan Cancer Institute, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - G Pareek
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - E Hyams
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| |
Collapse
|
2
|
Yu J, Khera N, Turnbull J, Stewart SK, Williams P, Bhatt V, Meyers O, Galvin J, Lee SJ. Impact of Chronic Graft-Versus-Host Disease (GVHD) on Patients' Employment, Income, and Informal Caregiver Burden: Findings From the Living With Chronic GVHD Patient Survey. Transplant Cell Ther 2023:S2666-6367(23)01235-6. [PMID: 37037267 DOI: 10.1016/j.jtct.2023.04.004] [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: 01/23/2023] [Revised: 03/10/2023] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Development of chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) results in impaired physical function and quality of life. However, limited data exist regarding the employment and financial impact on patients and caregivers. OBJECTIVE The objective of this study was to describe the impact of chronic GVHD on patient employment, disability leave, income, reliance on caregivers, and effects on caregiver employment. STUDY DESIGN The Living With Chronic GVHD Patient Survey was a cross-sectional online survey administered from May to August 2020 in the United States to adult HSCT survivors diagnosed with chronic GVHD within the past 5 years. Data on respondent demographics and disease characteristics and the effects of chronic GVHD on employment, income, and need for caregiver assistance were collected. Respondents were also asked to report on the impact of their chronic GVHD on their caregivers' employment. All data were summarized using descriptive statistics; no formal statistical comparisons were conducted. RESULTS A total of 165 respondents completed the survey (median age, 57.0 years; 63.6% women; 83.0% White); respondents had been experiencing chronic GVHD for a median (range) of 4.5 (0.1-36.7) years, with a median (range of 0.5 (0-3.6) years from most recent transplant to chronic GVHD diagnosis. Among those employed full- or part-time at the time of their most recent transplant (n=80), 61.3% reported taking disability leave, 58.8% worked reduced hours, 27.5% took a less demanding job, and 33.8% left a job because of chronic GVHD. Additionally, 71.3% believed they had lost income due to chronic GVHD. Among all respondents, 72.1% reported receiving regular caregiver assistance. Respondents commonly reported employment changes among unpaid caregivers (34.5% reduced their working hours; 16.6% terminated a job). CONCLUSIONS HSCT survivors who develop chronic GVHD are vulnerable to employment changes and financial hardship. This analysis highlights the need for effective therapies and improved symptom management to reduce the multifaceted burden of chronic GVHD on patients and their caregivers and ultimately improve long-term HSCT outcomes.
Collapse
Affiliation(s)
- Jingbo Yu
- Incyte Corporation, Wilmington, DE, USA;.
| | - Nandita Khera
- Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA
| | | | - Susan K Stewart
- Blood & Marrow Transplant Information Network, Highland Park, IL, USA
| | | | | | - Oren Meyers
- Patient Centered Solutions, IQVIA, Paris, France
| | | | | |
Collapse
|
3
|
El-Jawahri AR, Khera N, Lee CJ, Ponce DM, Bhatt V, Galvin J, Hamilton BK. Trial in Progress: A Prospective, Observational Cohort Study of Patients at Risk for Chronic Graft-Versus-Host Disease in the United States (THRIVE). Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00440-2] [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: 02/07/2023]
|
4
|
Mahmoudjafari Z, Socié G, Bhatt V, Galvin J, Xue Z, Mohty M. Impact of Cytopenias in Patients Treated with Ruxolitinib Versus Best Available Therapy for Steroid-Refractory Acute Graft-Versus-Host Disease: A REACH2 Post Hoc Analysis. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00413-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: 02/07/2023]
|
5
|
Yu J, Hamilton BK, Turnbull J, Stewart SK, Vernaya A, Bhatt V, Meyers O, Galvin J. Patient-reported symptom burden and impact on daily activities in chronic graft-versus-host disease. Cancer Med 2022; 12:3623-3633. [PMID: 36394207 PMCID: PMC9939096 DOI: 10.1002/cam4.5209] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/23/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic graft-versus-host disease (GVHD) is a potentially life-threatening complication of allogeneic hematopoietic stem cell transplantation (HSCT) treatment for hematologic malignancies. There are limited patient-reported data concerning symptom burden and effects on activities of daily living (ADL). METHODS The cross-sectional Living With Chronic GVHD Patient Survey was administered online in the United States (May-August 2020) to participants aged ≥18 years who underwent allogeneic HSCT, were diagnosed with chronic GVHD by a healthcare provider, and self-reported active chronic GVHD (within past 5 years). Information on patient demographics, disease characteristics, symptom burden, and ability to perform ADL was collected. Symptom burden was assessed using the validated Lee Symptom Scale (range from 0-100 with higher scores indicating greater burden). All data were summarized using descriptive statistics; no formal statistical comparisons were conducted. RESULTS Out of 580 participants who entered the survey screener, 165 participants (28.4%) across 33 states fulfilled all study eligibility criteria, completed the entire survey, and were included (age: mean [SD], 53.7 (13.8) years; median [range], 57.0 [18-78] years; female, n = 105 [63.6%]; White, n = 137 [83.0%]). Respondents described their chronic GVHD severity primarily as moderate (n = 54 [32.7%]) or severe (n = 102 [61.8%]) at the time when symptoms were at their worst. One-third of respondents (33.9%) indicated that their chronic GVHD symptoms were at their worst for ≥1 year in duration. Mean (SD; range) Lee Symptom Scale score was 44.8 (19.4; 2-100); 44% of respondents considered "dry eye" the most burdensome symptom. Almost half of respondents (n = 73 [44.2%]) rated their overall quality of life (QoL) as poor. Participants reported a detrimental impact of symptoms on ADL, including basic activities (eg, eating, personal hygiene, dressing). CONCLUSIONS Survey respondents self-reported high chronic GVHD symptom burden and felt that their symptoms severely interfered with physical function and ADL. Effective strategies to mitigate chronic GVHD symptoms are needed to improve QoL among HSCT survivors.
Collapse
Affiliation(s)
- Jingbo Yu
- Incyte CorporationWilmingtonDelawareUSA
| | | | | | - Susan K. Stewart
- Blood & Marrow Transplant Information NetworkHighland ParkIllinoisUSA
| | - Alla Vernaya
- Patient Centered Endpoints, IQVIANew YorkNew YorkUSA
| | | | - Oren Meyers
- Patient Centered Endpoints, IQVIANew YorkNew YorkUSA
| | | |
Collapse
|
6
|
Bell EJ, Yu J, Bhatt V, Bunner SH, Lal LS, Galvin J, Weisdorf D. Healthcare Resource Utilization and Costs of Steroid-Associated Complications in Patients With Graft-Versus-Host Disease. Transplant Cell Ther 2022; 28:707.e1-707.e7. [DOI: 10.1016/j.jtct.2022.04.014] [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] [Received: 09/24/2021] [Revised: 01/31/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022]
|
7
|
Yu J, Bhatt V, Galvin J, Jariwala-Parikh K, Thiel E. Extended Disability Leave and Related Costs Among Employed Patients with Graft-Versus-Host Disease (GVHD) Following Hematopoietic Cell Transplantation (HCT). Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00560-7] [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: 11/28/2022]
|
8
|
Yu J, Turnbull J, Stewart SK, Wartman L, Vernaya A, Bhatt V, Meyers O, Galvin J, Hamilton BK. Symptoms and Impact on Daily Activities and Functions in Patients with Chronic Graft-Versus-Host Disease (GVHD): Findings from the Living with Chronic GVHD Patient Survey. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
9
|
Joshi T, Joshi T, Sharma P, Mathpal S, Pundir H, Bhatt V, Chandra S. In silico screening of natural compounds against COVID-19 by targeting Mpro and ACE2 using molecular docking. Eur Rev Med Pharmacol Sci 2020; 24:4529-4536. [PMID: 32373991 DOI: 10.26355/eurrev_202004_21036] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Currently, Coronavirus COVID-19 is spreading worldwide very rapidly and its control is very difficult because there is no effective vaccine or drugs available in markets. This virus can infect both animals and people and cause illnesses of the respiratory tract. WHO has declared Coronavirus as pandemic and the whole world is fighting against Coronavirus. Globally, more than 199,478 people have been diagnosed with COVID-19. As of March 18, 2020, more than 167 countries have been affected and more than 8000 deaths have been reported. The main country being affected is China followed by Italy, Iran, Spain, France, and the USA. MATERIALS AND METHODS Since there are no effective drugs available against Coronavirus, we conducted virtual screening of phytochemicals to find novel compounds against this virus. Hence, we created a phytochemical library of 318 phytochemicals from 11 plants which have been reported as antiviral, antibacterial and antifungal activity. The phytochemical library was subjected to virtual screening against molecular targets; Main protease (Mpro) and Angiotensin-Converting Enzyme 2 (ACE2). RESULTS Top 10 compounds were selected from each target which had better and significantly low binding energy as compared to the reference molecule. CONCLUSIONS Based on the binding energy score, we suggest that these compounds can be tested against Coronavirus and used to develop effective antiviral drugs.
Collapse
Affiliation(s)
- T Joshi
- Department of Biotechnology, Kumaun University, Bhimtal Campus, Bhimtal, Uttarakhand, India.
| | | | | | | | | | | | | |
Collapse
|
10
|
Scordo M, Cho C, Devlin SM, Maloy MA, Ruiz JD, Bhatt V, Smith M, Shah GL, O'Reilly RJ, Papadopoulos EB, Jakubowski AA, Tamari R, Perales M, Giralt SA, Boelens JJ. Population Pharmacokinetic Model Demonstrates Poor Outcomes with ATG Overexposure in Adults Undergoing Ex Vivo CD34-Selected Allogeneic Hematopoietic Cell. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.710] [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]
|
11
|
Cavalier K, Cazeau N, Bhatt V, McElrath C, LeStrange NJ, Lachaud-Richard M, Inumerables F, Andrejko M, Batalha J, Cohen A, Cortes M, Kiss C, Palumbo D, Landau HJ, Lahoud OB, Dahi PB, Scordo M, Sauter CS, Giralt SA, Shah GL. Feasibility of and Decreased Inpatient Hospital Days for Non-Hodgkin Lymphoma (NHL) and Hodgkin Lymphoma (HL) Patients with Outpatient BEAM Using Daily Etoposide and Cytarabine and Autologous Hematopoietic Stem Cell Transplantation (AHCT). Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.712] [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]
|
12
|
Maples KT, Maloy M, Devlin S, Lin A, DeRespiris L, Griffin M, Lau C, Proli AJ, Papanicolaou GA, Seo SK, Barker JN, Perales MA, Giralt SA, Bhatt V. Lack of a significant pharmacokinetic interaction between letermovir and calcineurin inhibitors in allogeneic HCT recipients. Bone Marrow Transplant 2020; 55:1687-1689. [PMID: 31937928 DOI: 10.1038/s41409-020-0785-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Kathryn T Maples
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Molly Maloy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Devlin
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Lin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren DeRespiris
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meagan Griffin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carmen Lau
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony J Proli
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Genovefa A Papanicolaou
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Susan K Seo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Juliet N Barker
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Miguel-Angel Perales
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sergio A Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Valkal Bhatt
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
13
|
Gutgarts V, Sathick IJ, Zheng J, Politikos I, Devlin SM, Maloy MA, Giralt SA, Scordo M, Bhatt V, Glezerman I, Muthukumar T, Jaimes EA, Barker JN. Incidence and Risk Factors for Acute and Chronic Kidney Injury after Adult Cord Blood Transplantation. Biol Blood Marrow Transplant 2020; 26:758-763. [PMID: 31911259 DOI: 10.1016/j.bbmt.2019.12.768] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/17/2022]
Abstract
Although cord blood transplantation (CBT) extends allograft access, patient comorbidities, chemoradiation, and nephrotoxic medications all contribute to acute kidney injury (AKI) risk. We analyzed AKI in adult myeloablative CBT recipients who underwent transplantation from 2006 to 2017 for hematologic malignancies using cyclosporine A (CSA)/mycophenolate mofetil immunosuppression. Maximum grades of AKI were calculated using Kidney Disease: Improving Global Outcomes (grade 1, 1.5 to <2-fold; grade 2, 2 to <3-fold; or grade 3, ≥3-fold over baseline) definitions. In total, 153 patients (median 51 years [range, 23-65], 114/153 [75%] acute leukemia, 27/153 [18%] African, 88/153 [58%] cytomegalovirus seropositive, median age-adjusted hematopoietic cell comorbidity index 3 [range, 0-9], median pretransplant albumin 4.0 g/dL [range, 2.6-5.2]) underwent transplantation. The day 100 cumulative incidence of grade 1-3 AKI was 83% (95% confidence interval [CI], 77%-89%) (predominantly grade 2, median onset 40 days, range 0 to 96), and grade 2-3 AKI incidence was 54% (95% CI, 46%-62%) (median onset 43 days, range 0 to 96). Mean CSA level preceding AKI onset was high (360 ng/mL, target range 300-350). In multivariate analysis, African ancestry, addition of haploidentical CD34+ cells, low day -7 albumin, critical illness/intensive care admission, and nephrotoxic drug exposure (predominantly CSA and/or foscarnet) were associated with AKI. In a day 100 landmark analysis, 6% of patients with no prior AKI had chronic kidney disease (CKD) at 2 years versus 43% with prior grade 1 and 38% with prior grade 2-3 AKI (overall P= .02). Adult CBT recipients are at significant AKI risk, and AKI is associated with increased risk of CKD. Prevention strategies, early recognition, and prompt intervention are critical to mitigate kidney injury.
Collapse
Affiliation(s)
- Victoria Gutgarts
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Insara Jaffer Sathick
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Molly A Maloy
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio A Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Michael Scordo
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Valkal Bhatt
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ilya Glezerman
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Thangamani Muthukumar
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Edgar A Jaimes
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| |
Collapse
|
14
|
Lin A, Maloy M, Su Y, Bhatt V, DeRespiris L, Griffin M, Lau C, Proli A, Barker J, Shaffer B, Giralt SA, Jakubowski AA, Papadopoulos EB, Papanicolaou GA, Seo SK, Perales M. Letermovir for primary and secondary cytomegalovirus prevention in allogeneic hematopoietic cell transplant recipients: Real‐world experience. Transpl Infect Dis 2019; 21:e13187. [DOI: 10.1111/tid.13187] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/04/2019] [Accepted: 09/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Lin
- Department of Pharmacy Memorial Sloan Kettering Cancer Center New York NY USA
| | - Molly Maloy
- Adult Bone Marrow Transplant Service Department of Medicine Memorial Sloan Kettering Cancer Center New York NY USA
| | - Yiqi Su
- Infectious Disease Service Department of Medicine Memorial Sloan Kettering Cancer Center New York NY USA
| | - Valkal Bhatt
- Department of Pharmacy Memorial Sloan Kettering Cancer Center New York NY USA
| | - Lauren DeRespiris
- Department of Pharmacy Memorial Sloan Kettering Cancer Center New York NY USA
| | - Meagan Griffin
- Department of Pharmacy Memorial Sloan Kettering Cancer Center New York NY USA
| | - Carmen Lau
- Department of Pharmacy Memorial Sloan Kettering Cancer Center New York NY USA
| | - Anthony Proli
- Department of Pharmacy Memorial Sloan Kettering Cancer Center New York NY USA
| | - Juliet Barker
- Adult Bone Marrow Transplant Service Department of Medicine Memorial Sloan Kettering Cancer Center New York NY USA
- Department of Medicine Weill Cornell Medical College New York NY USA
| | - Brian Shaffer
- Adult Bone Marrow Transplant Service Department of Medicine Memorial Sloan Kettering Cancer Center New York NY USA
- Department of Medicine Weill Cornell Medical College New York NY USA
| | - Sergio A. Giralt
- Adult Bone Marrow Transplant Service Department of Medicine Memorial Sloan Kettering Cancer Center New York NY USA
- Department of Medicine Weill Cornell Medical College New York NY USA
| | - Ann A. Jakubowski
- Adult Bone Marrow Transplant Service Department of Medicine Memorial Sloan Kettering Cancer Center New York NY USA
- Department of Medicine Weill Cornell Medical College New York NY USA
| | - Esperanza B. Papadopoulos
- Adult Bone Marrow Transplant Service Department of Medicine Memorial Sloan Kettering Cancer Center New York NY USA
- Department of Medicine Weill Cornell Medical College New York NY USA
| | - Genovefa A. Papanicolaou
- Infectious Disease Service Department of Medicine Memorial Sloan Kettering Cancer Center New York NY USA
- Department of Medicine Weill Cornell Medical College New York NY USA
| | - Susan K. Seo
- Infectious Disease Service Department of Medicine Memorial Sloan Kettering Cancer Center New York NY USA
- Department of Medicine Weill Cornell Medical College New York NY USA
| | - Miguel‐Angel Perales
- Adult Bone Marrow Transplant Service Department of Medicine Memorial Sloan Kettering Cancer Center New York NY USA
- Department of Medicine Weill Cornell Medical College New York NY USA
| |
Collapse
|
15
|
Orozco JS, Hilden P, Maloy MA, Pappacena J, Buie LW, Shaffer BC, Papadopoulos EB, Jakubowski AA, Bhatt V. Busulfan/Melphalan/Fludarabine (Bu/Mel/Flu) Conditioning Versus Total Body Irradiation/Thiotepa/Cyclophosphamide (HFTBI/Thio/Cy) Based Conditioning in Patients with Acute Myeloid Leukemia (AML) or Myelodysplastic Syndrome (MDS) Undergoing CD34-Selected T-Cell Depleted Allogeneic Stem Cell Transplantation (alloSCT). Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
16
|
Scordo M, Bhatt V, Hilden P, Smith M, Thoren K, Cho C, Shah GL, Maloy MA, Papadopoulos EB, Jakubowski AA, Avecilla ST, O'Reilly RJ, Castro-Malaspina H, Tamari R, Shaffer BC, Boelens JJ, Perales MA, Giralt SA. Standard Antithymocyte Globulin Dosing Results in Poorer Outcomes in Overexposed Patients after Ex Vivo CD34 + Selected Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1526-1535. [PMID: 30831208 DOI: 10.1016/j.bbmt.2019.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/25/2019] [Indexed: 12/15/2022]
Abstract
Antithymocyte globulin (ATG) use mitigates the risk of graft rejection and graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (allo-HCT), but ATG overexposure in the setting of lymphopenia negatively affects immune recovery. We hypothesized that standard empiric weight-based dosing of ATG, used to prevent graft rejection in ex vivo CD34-selected allo-HCT, may lead to serious adverse consequences on outcomes in certain patients. We evaluated 304 patients undergoing myeloablative-conditioned ex vivo CD34-selected allo-HCT with HLA-matched donors for the treatment of hematologic malignancies. Patients received rabbit ATG at a dose of 2.5 mg/kg/day i.v. on days -3 and/or -2. An ATG dosing cutoff of 450 mg was used for statistical analyses to assess the relationship between ATG and overall survival (OS). Among all patients, median total ATG dose was 360 mg (range, 130 to 510 mg); 279 (92%) received a total dose of ATG ≤450 mg, and 25 (8%) received a total dose >450 mg. On the first day of ATG administration (day -3), the median absolute lymphocyte count was .0 K/µL. For patients who received a total dose of ATG >450 mg or ≤450 mg, the incidences of acute and late-acute GVHD grade II-IV were statistically similar. At 3 years post-HCT, for patients who received a total dose of ATG >450 mg or ≤450 mg, nonrelapse mortality (NRM) rates were 35% and 18%, respectively (P = .029), disease-free survival (DFS) rates were 37% and 61%, respectively (P = .003), and OS rates were 40% and 67%, respectively (P = .001). Among all patient and HCT characteristics in multivariable analyses, receipt of a total dose of ATG >450 mg was associated with an increased risk of NRM (hazard ratio [HR], 2.9; P = .01), shorter DFS (HR, 2.0; P = .03), and inferior OS (HR, 2.1; P = .01). In summary, the use of weight-based ATG at a time of relative lymphopenia before ex vivo CD34-selected allo-HCT results in overdosing in heavier patients, leading to higher NRM and lower DFS and OS. Further pharmacokinetic investigation in this setting is critical to determining the optimal dosing strategy for ATG.
Collapse
Affiliation(s)
- Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - Valkal Bhatt
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Patrick Hilden
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melody Smith
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Katie Thoren
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christina Cho
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Molly A Maloy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Esperanza B Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ann A Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Scott T Avecilla
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J O'Reilly
- Pediatric Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Hugo Castro-Malaspina
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Brian C Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jaap J Boelens
- Pediatric Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| |
Collapse
|
17
|
Maples KT, Maloy MA, Lin A, DeRespiris L, Griffin M, Lau C, Proli AJ, Papanicolaou GA, Seo SK, Barker JN, Perales MA, Giralt SA, Bhatt V. Lack of a Significant Pharmacokinetic Interaction between Letermovir and Calcineurin Inhibitors in Allogeneic HCT Recipients. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.181] [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]
|
18
|
Lau C, Politikos I, Maloy MA, Naputo K, Afuye A, Devlin SM, Bhatt V, Giralt SA, Jakubowski AA, Papadopoulos EB, Perales MA, Shaffer BC, Seo SK, Papanicolaou GA, Barker JN. Letermovir Prophylaxis Demonstrates High Efficacy in Adult Cytomegalovirus (CMV) Seropositive Cord Blood Transplant (CBT) Recipients: A Comparison with Pre-Letermovir Era CBT Controls. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
Proli AJ, Bhatt V, Lin A, Lau C, Griffin M, DeRespiris L, Maples KT, Figgins B. A Retrospective Analysis of the Effect of Isavuconazole on Immunosuppressant Serum Blood Levels and Intravenous to Oral Dose Adjustments. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
DeRespiris L, Bhatt V, Lin A, Maloy MA, Chung DJ, Landau H, Scordo M, Giralt SA, Shah GL. Toxicity Analysis of Propylene Glycol-Free Melphalan (Evomela®) Compared to Propylene Glycol-Based Melphalan Hydrochloride in Autologous Hematopoietic Cell Transplantation for Multiple Myeloma. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Bhatt V. Current market and regulatory landscape of biosimilars. Am J Manag Care 2018; 24:S451-S456. [PMID: 30452213] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The introduction of biologic therapies has improved the treatment landscape for multiple diseases, particularly in the areas of oncology, rheumatology, and endocrinology. Although they are effective, biologics are associated with increased costs that result in economic burden for healthcare professionals and patients. Biosimilars are biologic medical products that are almost an identical copy of the original product. There are differences in the regulatory requirements for the original biologic product and a biosimilar, as biosimilars gain FDA approval through an abbreviated approval pathway. The incorporation of these products into the US market will potentially result in improved patient access and decreased healthcare costs. There are barriers, such as lack of familiarity, that affect the use of biosimilars. Strategies to overcome these barriers are essential to improve the uptake of these products in the United States.
Collapse
Affiliation(s)
- Valkal Bhatt
- Clinical Oncology Pharmacy Specialist, Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY.
| |
Collapse
|
22
|
Shah GL, Lin A, Schofield R, Sarubbi C, Preston EV, Devlin SM, Bhatt V, Harnicar S, Hoover E, Chung DJ, Dahi PB, Koehne G, Tamari R, Wang P, Giese R, Carlow D, Giralt SA, Landau H. Feasibility and Toxicity of Pharmacokinetic (PK)-Directed Dosing of Evomela® (propylene glycol free melphalan, PGF-MEL) for Multiple Myeloma (MM) and AL Amyloidosis (AL) Patients Undergoing Autologous Hematopoietic Stem Cell Transplant (AHCT). Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.072] [Citation(s) in RCA: 2] [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: 11/29/2022]
|
23
|
Shah GL, Landau H, Sarubbi C, Schofield R, Lin A, Bhatt V, Harnicar S, Devlin SM, Castro-Malaspina H, Chung DJ, Dahi PB, Gyurkocza B, Koehne G, Matasar MJ, Moskowitz CH, Papadopoulos EB, Sauter CS, Shaffer BC, Tamari R, Carlow D, Giralt SA. Pharmacokinetics and Toxicities after Evomela® (Propylene Glycol Free Melphalan) with Hematopoietic Stem Cell Transplant (HCT) for Multiple Myeloma (MM), AL Amyloidosis (AL), Lymphoma, Acute Myeloid Leukemia (AML), and Myelodysplastic Syndrome (MDS). Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
Pappacena J, Bhatt V, Shah GL, Hilden P, Maloy M, Buie LW, Giralt SA, Scordo M. More Intensive Fludarabine/Busulfan (Flu/Bu) Conditioning Regimens Result in Similar Outcomes Without Adding Serious Toxicity When Compared to Fludarabine/Melphalan (Flu/Mel) in Patients Undergoing Allogeneic Hematopoietic Cell Transplant (Allo-HCT). Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
25
|
Bhatt V, Politikos I, Devlin SM, Jacob AG, Maloy M, Naputo K, Afuye A, Scaradavou A, O'Reilly RJ, Castro-Malaspina H, Dahi PB, Giralt SA, Gyurkocza B, Jakubowski AA, Papadopoulos EB, Peled JU, Hanash AM, Perales MA, Sauter CS, Shaffer BC, Shah GL, Tamari R, van den Brink MR, Young JW, Ponce DM, Barker JN. Therapeutic Cyclosporine-a (CSA) Levels in the First 7 Days after Cord Blood Transplantation (CBT) Are Critical to Prevent Severe Acute Graft-Versus-Host Disease (aGVHD). Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Scordo M, Bhatt V, Smith M, Thoren K, Hilden P, Cho C, Shah GL, Maloy M, Papadopoulos EB, Jakubowski AA, O'Reilly RJ, Castro-Malaspina H, Tamari R, Shaffer BC, Perales MA, Giralt SA. Empiric Anti-Thymocyte Globulin (ATG) Dosing in Ex-Vivo CD34-Selected Myeloablative Allogeneic Hematopoietic Cell Transplantation (Allo-HCT) May Result in ATG Overexposure That Negatively Affects Outcomes. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.653] [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: 11/27/2022]
|
27
|
Kenny S, Collum K, Featherstone C, Bhatt V, Irby S, Kelly S, Montefusco M, Morcerf B, Patterson E, Taylor J, Farooki A, Jakubowski AA. Impact of Hematopoietic Stem Cell Transplant (HSCT) Vitamin D Algorithm on Vitamin D Levels of HSCT Patients—Part II. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.696] [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]
|
28
|
Lau C, Politikos I, Devlin SM, Jacob AG, Maloy M, Naputo K, Afuye A, Bhatt V, Dahi PB, Perales MA, Giralt SA, O'Reilly RJ, Ponce DM, Prockop SE, Shah GL, Papanicolaou GA, Scaradavou A, Barker JN. Analysis of Cytomegalovirus (CMV) Infections in the First 180 Days in Adult Sero-Positive Cord Blood Transplantation (CBT) Recipients Reveals High Infection Rates and Treatment Burden. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.465] [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: 10/18/2022]
|
29
|
Brezina L, Maharaj K, Rathod N, Bhatt V. Outcomes on implementing an emergency daytime theatre for oral and maxillofacial surgery at Mid-Essex Hospital Trust. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.275] [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]
|
30
|
Bhatt V, Parrish J, Chhabra P, Nute S. Miniplate temporary orthodontic bone anchorage devices for maxillary molar intrusion — the challenges. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.896] [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: 10/19/2022]
|
31
|
Lau C, Bhatt V, Dahi P, Devlin SM, Yoo Y, Adel NG, Mazis C, Perales MA, Giralt SA, Koehne G, Ponce DM, Papanicolaou GA, Barker JN. Incidence, Severity, Day 100 Treatment Efficacy and Therapy Toxicity of Cytomegalovirus (CMV) Infections with Early Pre-Emptive Therapy in Adult Cord Blood (CB) Transplant Recipients. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.371] [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]
|
32
|
Lin A, Drill E, Proli AJ, Beyer K, Bhatt V, Devlin SM, Koehne G. Impact of Busulfan Exposure on Transplant Outcomes for Patients with Relapsed Multiple Myeloma Undergoing CD34-Selected Allogeneic Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.200] [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]
|
33
|
Bhatt V, Parrish J, Kerai T, Nute S, Singh A, Chhabra P. Patient satisfaction with orthognathic treatment — does the view change with time? Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.1076] [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: 10/19/2022]
|
34
|
Scordo M, Bhatt V, Hsu M, Omuro AM, Matasar MJ, DeAngelis LM, Dahi PB, Moskowitz CH, Giralt SA, Sauter CS. A Comprehensive Assessment of Toxicities in Patients with Central Nervous System Lymphoma Undergoing Autologous Stem Cell Transplantation Using Thiotepa, Busulfan, and Cyclophosphamide Conditioning. Biol Blood Marrow Transplant 2016; 23:38-43. [PMID: 27713090 DOI: 10.1016/j.bbmt.2016.09.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/30/2016] [Indexed: 11/17/2022]
Abstract
High-dose therapy and autologous stem cell transplantation (ASCT) with thiotepa, busulfan, and cyclophosphamide (TBC) conditioning has emerged as an effective postinduction treatment strategy for patients with primary central nervous system lymphoma (PCNSL) or secondary central nervous system lymphoma (SCNSL), but it is associated with considerable toxicity and transplantation-related mortality (TRM) in the modern era. Forty-three adult patients with chemosensitive PCNSL or SCNSL underwent TBC-conditioned ASCT between 2006 and 2015. Twenty-eight of these patients received pharmacokinetically (PK)-targeted busulfan dosing. The median number of clinically relevant individual grade ≥3 nonhematologic toxicities per patient was 5. We found no association between pretransplantation patient characteristics and the presence of more than 5 grade ≥3 nonhematologic toxicities. Patients with elevated first-dose busulfan area under the curve values did not experience more toxicity. Paradoxically, patients treated with more than 2 regimens before undergoing ASCT had lower first-dose busulfan AUC values. With a median follow-up among survivors of 20 months, 1-year progression-free survival (PFS) and overall survival (OS) from the time of ASCT were 83% and 87%, respectively. Although this study reaffirms the favorable PFS and OS associated with TBC-conditioned ASCT for PCNSL or SCNSL, this treatment strategy carries a large toxicity burden.
Collapse
Affiliation(s)
- Michael Scordo
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Valkal Bhatt
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meier Hsu
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Antonio M Omuro
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Matthew J Matasar
- Department of Medicine, Lymphoma Service, Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Parastoo B Dahi
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig H Moskowitz
- Department of Medicine, Lymphoma Service, Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio A Giralt
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig S Sauter
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| |
Collapse
|
35
|
Bhatt V, Lin A, Beyer K, Proli A, Yoo Y, Ponce D, Barker J. Analysis of Cyclosporine A Levels Supports New Dosing Guidelines in Adult Double-Unit Cord Blood Transplant Recipients to Optimize Immunosuppression Early Post-Transplant. Biol Blood Marrow Transplant 2016; 22:1533-1534. [DOI: 10.1016/j.bbmt.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/02/2016] [Indexed: 01/02/2023]
|
36
|
Bhatt V, Lin A, Beyer K, Proli AJ, Yoo Y, Lauer E, Giralt SA, Ponce DM, Barker JN. Analysis of Cyclosporine-a (CSA) Levels Supports New Dosing Guidelines in Adult Double Unit Cord Blood Transplant (dCBT) Recipients to Optimize Immunosuppression Early Post-Transplant. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.1086] [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: 11/27/2022]
|
37
|
Bhatt V, Palazzo M, Kilroy K, Hilden P, Devlin SM, Maloy M, Barker JN, Castro-Malaspina H, Chung DJ, Dahi P, Hsu KC, Hanash AM, Jakubowski AA, Jenq R, Koehne G, Landau H, Papadopoulos E, Perales MA, Sauter CS, Tamari R, van den Brink MR, Young JW, Giralt SA, Ponce DM. Low Dose Unfractionated Heparin (UFH) Prophylaxis Is a Feasible Strategy for the Prevention of Hepatic Sinusoidal Obstruction Syndrome (SOS) after Myeloablative Adult Allogeneic Hematopoietic Stem Cell Transplantation (HSCT). Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.740] [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: 11/24/2022]
|
38
|
Scordo M, Bhatt V, Hsu M, Omuro AM, Matasar MJ, DeAngelis L, Dahi P, Moskowitz CH, Giralt SA, Sauter CS. Toxicities and Outcomes for Patients with CNS Lymphoma (CNSL) Consolidated with High-Dose Therapy and Autologous Stem Cell Transplantation (HDT-ASCT) Using Thiotepa, Pharmacokinetically-Targeted (PK) Busulfan (Bu), Cyclophosphamide (TBC) Conditioning. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.465] [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: 10/22/2022]
|
39
|
Shah GL, Shune L, Purtill D, Devlin S, Lauer E, Lubin M, Bhatt V, McElrath C, Kernan NA, Scaradavou A, Giralt S, Perales MA, Ponce DM, Young JW, Shah M, Papanicolaou G, Barker JN. Robust Vaccine Responses in Adult and Pediatric Cord Blood Transplantation Recipients Treated for Hematologic Malignancies. Biol Blood Marrow Transplant 2015; 21:2160-2166. [PMID: 26271191 PMCID: PMC4672874 DOI: 10.1016/j.bbmt.2015.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 04/23/2015] [Accepted: 08/05/2015] [Indexed: 01/04/2023]
Abstract
Because cord blood (CB) lacks memory T and B cells and recent decreases in herd immunity to vaccine-preventable diseases in many developed countries have been documented, vaccine responses in CB transplantation (CBT) survivors are of great interest. We analyzed vaccine responses in double-unit CBT recipients transplanted for hematologic malignancies. In 103 vaccine-eligible patients, graft-versus-host disease (GVHD) most commonly precluded vaccination. Sixty-five patients (63%; engrafting units median HLA-allele match 5/8; range, 2 to 7/8) received protein conjugated vaccines, and 63 patients (median age, 34 years; range, .9 to 64) were evaluated for responses. Median vaccination time was 17 months (range, 7 to 45) post-CBT. GVHD (n = 42) and prior rituximab (n = 13) delayed vaccination. Responses to Prevnar 7 and/or 13 vaccines (serotypes 14, 19F, 23F) were seen in children and adults (60% versus 49%, P = .555). Responses to tetanus, diphtheria, pertussis, Haemophilus influenzae, and polio were observed in children (86% to 100%) and adults (53% to 89%) even if patients had prior GVHD or rituximab. CD4(+)CD45RA(+) and CD19(+) cell recovery significantly influenced tetanus and polio responses. In a smaller cohort responses were seen to measles (65%), mumps (50%), and rubella (100%) vaccines. No vaccine side effects were identified, and all vaccinated patients survived (median follow-up, 57 months). Although GVHD and rituximab can delay vaccination, CBT recipients (including adults and those with prior GVHD) have similar vaccine response rates to adult donor allograft recipients supporting vaccination in CBT recipients.
Collapse
Affiliation(s)
- Gunjan L Shah
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leyla Shune
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Duncan Purtill
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily Lauer
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marissa Lubin
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valkal Bhatt
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Courtney McElrath
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy A Kernan
- Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andromachi Scaradavou
- Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Miguel A Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Doris M Ponce
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - James W Young
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Monica Shah
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Genovefa Papanicolaou
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| |
Collapse
|
40
|
Palumbo D, Bhatt V. Correction of secondary facial deformity using patient specific implants designed by CAD/CAM technology. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.473] [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]
|
41
|
Bhatt V, Pillai R. Efinaconazole topical solution, 10%: formulation development program of a new topical treatment of toenail onychomycosis. J Pharm Sci 2015; 104:2177-82. [PMID: 25940933 DOI: 10.1002/jps.24459] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 10/31/2014] [Revised: 03/27/2015] [Accepted: 03/31/2015] [Indexed: 11/07/2022]
Abstract
Transungual drug delivery of antifungals is considered highly desirable to treat common nail disorders such as onychomycosis, due to localized effects, and improved adherence resulting from minimal systemic adverse events. However, the development of effective topical therapies has been hampered by poor nail penetration. An effective topical antifungal must permeate through, and under the dense keratinized nail plate to the site of infection in the nail bed and nail matrix. We present here the formulation development program to provide effective transungual and subungual delivery of efinaconazole, the first topical broad spectrum triazole specifically developed for onychomycosis treatment. We discuss the important aspects encompassing the formulation development program for efinaconazole topical solution, 10%, focusing on its solubility in a number of solvents, in vitro penetration through the nail, and in vivo efficacy. Efinaconazole topical solution, 10% is a stable, non-lacquer, antifungal with a unique combination of ingredients added to an alcohol-based formulation to provide low surface tension and good wetting properties. This low surface tension is believed to affect effective transungual delivery of efinaconazole and believed to provide a dual mode of delivery by accessing the nail bed by wicking into the space between the nail and nail plate.
Collapse
Affiliation(s)
- V Bhatt
- Dow Pharmaceutical Sciences (A Division of Valeant Pharmaceutical North America LLC), Petaluma, California
| | - R Pillai
- Dow Pharmaceutical Sciences (A Division of Valeant Pharmaceutical North America LLC), Petaluma, California
| |
Collapse
|
42
|
Ponce DM, Devlin S, Bhatt V, Pozotrigo M, Lubin M, Lauer E, Kernan NA, Scaradavou A, Hanash AM, Perales MA, van den Brink MR, Young JW, Giralt S, Barker J. In Landmark Analysis the Severity of Day 100 Acute Graft-Versus-Host Disease (aGVHD) Has No Impact on Long-Term Progression-Free Survival (PFS) after Double-Unit Cord Blood Transplantation (DCBT). Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.551] [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: 10/24/2022]
|
43
|
Dowell J, Bertke M, Bhatt V, Guan Y, Jin S, Warhadpande S, Sarbinoff J, Erdal S, Spain J, Gadkari M. Lean Six Sigma approach to improving IR scheduling. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.564] [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: 10/24/2022] Open
|
44
|
Coffey G, Kenny S, Jackson L, Bhatt V. Determining the value of weekly surveillance blood cultures as a screening tool for occult bloodstream infection for post allogeneic hematopoietic stem cell transplant (HSCT) patients on Prednisone. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
45
|
Bhatt V, Alejandro L, Michael A, Ganetsky A. The promising impact of ibrutinib, a Bruton's tyrosine kinase inhibitor, for the management of lymphoid malignancies. Pharmacotherapy 2013; 34:303-14. [PMID: 24338680 DOI: 10.1002/phar.1366] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lymphoid malignancies comprise a heterogeneous group of disorders originating from clonal proliferation of B or T lymphocytes. Treatment of lymphoid neoplasms has traditionally been pursued with cytotoxic chemotherapy. To improve efficacy and ameliorate the adverse effects associated with classic chemotherapy, molecularly targeted therapy has been developed. At the forefront of clinical development is ibrutinib, an inhibitor of Bruton's tyrosine kinase (Btk). Btk is a protein tyrosine kinase that plays an important role in regulating B-cell signaling. Dysregulated Btk results in uncontrolled B-lymphocyte proliferation, differentiation, and survival. Ibrutinib is currently being studied in numerous malignancies of lymphoid origin including chronic lymphocytic leukemia, mantle cell lymphoma, non-Hodgkin lymphoma, follicular lymphoma, and multiple myeloma. Thus far, ibrutinib has demonstrated very promising results in treatment-naive patients as well as those with relapsed or refractory disease with an acceptable safety profile. In this article, we describe the pharmacology, efficacy, and toxicity profile of ibrutinib and depict the potential role that ibrutinib will play in the treatment paradigm of lymphoid neoplasms.
Collapse
Affiliation(s)
- Valkal Bhatt
- Department of Pharmacy, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | | |
Collapse
|
46
|
Parmar SR, Bhatt V, Yang J, Zhang Q, Schuster M. A retrospective review of metronidazole and vancomycin in the management of Clostridium difficile infection in patients with hematologic malignancies. J Oncol Pharm Pract 2013; 20:172-82. [DOI: 10.1177/1078155213490004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The incidence and severity of Clostridium difficile infection has significantly increased over the past decade. Although the epidemiology and treatment of C. difficile infection is well elucidated in the non-oncology population, it is poorly understood among cancer patients. This illustrates great concern as the majority of these patients are immunosuppressed, which puts them at higher risk for developing severe disease. Furthermore, suboptimal treatment of C. difficile infection can compromise care of underlying malignancy. Due to limited amount of data, we conducted this study to better ascertain the epidemiology and treatment outcomes of C. difficile infection in a subset of oncology patients at our institution. Objectives The primary objective was to assess the incidence and severity of C. difficile infection in patients with hematologic malignancies, including those undergoing hematopoietic stem cell transplant for a hematologic condition. The secondary objectives were to assess: (a) the outcome of C. difficile infection after therapy with metronidazole and/or vancomycin and (b) mortality following C. difficile infection. Methods We performed a retrospective study to assess the incidence and severity of C. difficile infection and to evaluate outcomes of therapy with metronidazole and/or vancomycin among adult patients admitted to the Malignant Hematology/Blood and Marrow Transplantation service at our center from January 2009 to 2012. Results Of the 390 admitted patients during the 3-year study period, the overall incidence of C. difficile infection was 18.7% ( n = 73). Forty-six patients (63.0%) were deemed to have mild-moderate C. difficile infection. With regards to outcome of therapy, less exposure to antimicrobial agents was significantly associated with a higher resolution rate ( p = 0.0029). Response rates to metronidazole were 53.7%, vancomycin 50%, and combination therapy 38.5%, although no difference in achievement of resolution was found among the three treatment modalities ( p = 0.5533). Older patients were more likely to experience recurrent C. difficile infection ( p = 0.0007). It was found that 55 patients (75.3%) were alive at 6 months. Conclusions These results highlight the high incidence of C. difficile infection in a subset of cancer patients at our institution. Although most patients presented with mild-moderate disease, severity of C. difficile infection in cancer patients may be underestimated due to the frequent presence of neutropenia. This study is the first analysis conducted, which directly compares outcomes of C. difficile infection after therapy with metronidazole, vancomycin, or combination therapy exclusively in patients with hematologic malignancies, including those undergoing hematopoietic stem cell transplant for a hematologic condition. We found no difference in treatment outcomes among metronidazole, vancomycin, or combination therapy. The recommendation from the literature to use metronidazole as the initial drug of choice for mild-moderate C. difficile infection is a reasonable option, although the rate of cure is low. This study highlights the critical need for better treatment options, due to suboptimal response rates to current therapy. Larger scale studies are needed to better understand the epidemiology and management of C. difficile infection in this patient population.
Collapse
Affiliation(s)
- Sapna R Parmar
- Department of Pharmacy, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Valkal Bhatt
- Department of Pharmacy, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Jie Yang
- Department of Preventative Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Qiao Zhang
- Department of Applied Mathematics and Statistics, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Michael Schuster
- Department of Medicine, Stony Brook University Hospital,Stony Brook, NY, USA
| |
Collapse
|
47
|
Abstract
OBJECTIVE To review the available literature addressing the treatment of pancreatic neuroendocrine tumors (PNETs) and carcinoid tumors. DATA SOURCES Relevant literature was identified by a PubMed search (January 1977-December 2011) of English-language literature using the terms gastroenteropancreatic neuroendocrine tumor, pancreatic neuroendocrine, carcinoid, and pancreatic islet cell tumor. STUDY SELECTION AND DATA EXTRACTION All published studies and abstracts, as well as relevant consensus guidelines, evaluating the current literature about PNETs and carcinoid tumors were included. DATA SYNTHESIS Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a genetically diverse group of complex malignancies with varying biological and clinical courses. Historically believed to be rare, recent epidemiologic data suggest their incidence is rising. Two of the most commonly diagnosed GEP-NETs are PNETs and carcinoid tumors. Both subtypes are well-differentiated tumors and present as low or intermediate grade. The systemic manifestations of PNETs and carcinoid tumors are diverse and are related to the secretion of affected hormones and biogenic amines. Surgical resection of localized disease remains the only curative option. However, the utility of this approach is limited because most patients are diagnosed with advanced disease. Recent advances have led to an improvement in outcomes in patients with PNETs and carcinoid tumors. This review describes traditional therapies as well as emerging strategies being investigated to help manage these cancers. Treatment of poorly differentiated GEP-NETs is beyond the scope of this review. CONCLUSIONS The advent of new therapies for PNETs and carcinoid tumors has introduced a paradigm shift in the management of this heterogeneous malignancy.
Collapse
Affiliation(s)
- Alex Ganetsky
- Pharmacy Department, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | | |
Collapse
|
48
|
Bhatt V, Barnard N. Tension free vaginal tape in static facial reanimation: new use for a well tested device. Ann R Coll Surg Engl 2011. [PMID: 22041249 DOI: 10.1308/003588411x13165261994238d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- V Bhatt
- Worcester Royal Infirmary, Worcester, UK.
| | | |
Collapse
|
49
|
Bhatt V, Barnard N. Tension free vaginal tape in static facial reanimation: new use for a well tested device. Ann R Coll Surg Engl 2011; 93:648-648. [DOI: 10.1308/rcsann.2011.93.8.648b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- V Bhatt
- Worcester Royal Infirmary Worcester, UK
| | - N Barnard
- Worcester Royal Infirmary Worcester, UK
| |
Collapse
|
50
|
Abstract
The successful management of midface and craniofacial trauma requires a thorough understanding of the anatomy and functional demands of this complex region. To achieve optimal outcomes, it is necessary that these injuries are accurately diagnosed and managed in a multi-disciplinary environment at the appropriate time. This review article discusses an overview of these injuries and highlights some of the key principles of management.
Collapse
Affiliation(s)
- K McVeigh
- Oral and Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, UK
- Oral and Maxillofacial Surgery, Royal Gwent Hospital, Newport, South Wales, UK
| | - V Bhatt
- Oral and Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, UK
| | - J Green
- Oral and Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, UK
| | - A Monaghan
- Oral and Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, UK
| | - MS Dover
- Oral and Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, UK
| |
Collapse
|