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Ahmed S, Zhao Q, Hanel W, Qazilbash MH, Patel K, Narra R, Kansagra A, Iqbal M, Awan FT, Christian B, Jaglowski SM, Kharfan-Dabaja MA, Hamadani M, Epperla N. Post-relapse survival in Waldenstrom macroglobulinemia patients experiencing therapy failure following autologous transplantation. Hematol Oncol 2021; 40:48-56. [PMID: 34763367 DOI: 10.1002/hon.2946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 11/05/2022]
Abstract
Waldenström macroglobulinemia (WM) is a rare B-cell lymphoproliferative malignancy. Autologous hematopoietic cell transplantation (auto-HCT) is considered in a subset of WM patients with relapsed disease. While registry data has shown a benefit for auto-HCT in relapsed WM, there is a paucity of data on outcomes of patients relapsing after auto-HCT. Eligibility criteria included adult patients with relapsed/refractory WM who underwent auto-HCT between 2007 and 2017. The primary endpoint was post-relapse overall survival (PR-OS). Secondary endpoints were to identify factors prognostic of PR-OS. Of the 48 patients with WM who underwent auto-HCT, 22 (46%) experienced relapse following auto-HCT. Median PR-OS of relapsed WM patients after auto-HCT (n = 22) was not reached (NR) (95% confidence interval [CI]: 17.5 months-NR). Among patients who relapsed <1 year versus ≥1 year from auto-HCT, the median PR-OS was 18.4 months (95%CI: 0.8-NR) months and NR (95%CI: 17.5-NR), respectively (p = 0.06). Of note, disease status at the time of transplant, CR/VGPR versus partial remission did not appear to impact PR-OS. The median PR-OS was significantly longer in patients who received ibrutinib in the post-transplant setting compared to those who did not (NR vs. 18.4 months, 95%CI: 9.1-NR, p = 0.02). On univariable analysis, the presence of complex karyotype (RR = 4.87, 95% CI = 1.22-19.53) and a higher number of prior lines of therapy (RR = 1.81, 95% CI = 1.23-2.67) were associated with a significantly higher risk of relapse. This is the only study to date that evaluated outcomes of WM patients who relapsed following auto-HCT and provides a benchmark for future trials evaluating survival following auto-HCT relapse.
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Affiliation(s)
- Sairah Ahmed
- Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas, USA.,Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Qiuhong Zhao
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Walter Hanel
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Krina Patel
- Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Ravi Narra
- Department of Medicine, BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ankit Kansagra
- Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madiha Iqbal
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Farrukh T Awan
- Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Beth Christian
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Samantha M Jaglowski
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Mehdi Hamadani
- Department of Medicine, BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Narendranath Epperla
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
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El-Jawahri A, Chen YB, Brazauskas R, He N, Lee SJ, Knight JM, Majhail N, Buchbinder D, Schears RM, Wirk BM, Wood WA, Ahmed I, Aljurf M, Szer J, Beattie SM, Battiwalla M, Dandoy C, Diaz MA, D'Souza A, Freytes CO, Gajewski J, Gergis U, Hashmi SK, Jakubowski A, Kamble RT, Kindwall-Keller T, Lazarus HM, Malone AK, Marks DI, Meehan K, Savani BN, Olsson RF, Rizzieri D, Steinberg A, Speckhart D, Szwajcer D, Schoemans H, Seo S, Ustun C, Atsuta Y, Dalal J, Sales-Bonfim C, Khera N, Hahn T, Saber W. Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation. Cancer 2017; 123:1828-1838. [PMID: 28102896 DOI: 10.1002/cncr.30546] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/23/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND To evaluate the impact of depression before autologous and allogeneic hematopoietic cell transplantation (HCT) on clinical outcomes post-transplantation. METHODS We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n = 3786) or allogeneic (n = 7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment versus those without pre-HCT depression. Using Cox regression models, we compared overall survival (OS) between patients with or without depression. We compared the number of days alive and out of the hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade 2-4 acute and chronic graft-versus-host disease (GVHD) in allogeneic HCT. RESULTS The study included 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression who underwent allogeneic HCT between 2008 and 2012. Pre-transplant depression was associated with lower OS (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.04-1.23; P = 0.004) and a higher incidence of grade 2-4 acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; P < 0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days-alive-and-out-of-the hospital (means ratio [MR] = 0.97; 95% CI, 0.95-0.99; P = 0.004). There were 512 (13.5%) patients with Pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT was not associated with OS (HR, 1.15; 95% CI, 0.98-1.34; P = 0.096) but was associated with fewer days alive and out of the hospital (MR, 0.98; 95% CI, 0.97-0.99; P = 0.002). CONCLUSION Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients and fewer days alive and out of the hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a population that is at risk for post-transplant complications. Cancer 2017;123:1828-1838. © 2017 American Cancer Society.
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Affiliation(s)
| | - Yi-Bin Chen
- Massachusetts General Hospital, Boston, Massachusetts
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.,Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Naya He
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Jennifer M Knight
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | | | - William A Wood
- University of North Carolina, Chapel Hill, North Carolina
| | - Ibrahim Ahmed
- The Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Jeff Szer
- Royal Melbourne Hospital, Victoria, Australia
| | | | | | | | | | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cesar O Freytes
- University of Texas Health Science Center San Antonio, San Antonio, Texas
| | | | - Usama Gergis
- New York Presbyterian Hospital, New York, New York
| | | | - Ann Jakubowski
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | | | | | - David I Marks
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Kenneth Meehan
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard F Olsson
- Karolinska Institute, Stockholm, Sweden.,Uppsala University, Uppsala, Sweden
| | | | | | | | | | | | | | | | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jignesh Dalal
- The Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | | | | | - Theresa Hahn
- Roswell Park Cancer Institute, Buffalo, New York
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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