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Gerson JN, Handorf E, Villa D, Gerrie AS, Chapani P, Li S, Medeiros LJ, Wang M, Cohen JB, Churnetski M, Hill BT, Sawalha Y, Hernandez-Ilizaliturri FJ, Kothari S, Vose JM, Bast M, Fenske T, Rao Gari SN, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B, Lansigan F, Burns T, Donovan AM, Wagner-Johnston N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Ristow K, Karmali R, Kaplan JB, Caimi PF, Rajguru S, Evens A, Klein A, Umyarova E, Pulluri B, Amengual JE, Lue JK, Diefenbach C, Fisher RI, Barta SK. Outcomes of patients with blastoid and pleomorphic variant mantle cell lymphoma. Blood Adv 2023; 7:7393-7401. [PMID: 37874912 PMCID: PMC10758713 DOI: 10.1182/bloodadvances.2023010757] [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: 05/16/2023] [Revised: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma; data indicate that blastoid and pleomorphic variants have a poor prognosis. We report characteristics and outcomes of patients with blastoid/pleomorphic variants of MCL. We retrospectively studied adults with newly diagnosed MCL treated from 2000 to 2015. Primary objectives were to describe progression-free survival (PFS) and overall survival (OS). Secondary objectives included characterization of patient characteristics and treatments. Of the 1029 patients with MCL studied, a total of 207 neoplasms were blastoid or pleomorphic variants. Median follow-up period was 82 months (range, 0.1-174 months); median PFS was 38 months (95% confidence interval [CI], 28-66) and OS was 68 months (95% CI, 45-96). Factors associated with PFS were receipt of consolidative autologous hematopoietic transplantation (auto-HCT; hazard ratio [HR], 0.52; 95% CI, 0.31-0.80; P < .05), MCL International Prognostic Index (MIPI) intermediate (HR, 2.3; 95% CI, 1.2-4.3; P < .02) and high (HR, 3.8; 95% CI, 2.0-7.4; P < .01) scores, and complete response to induction (HR, 0.29 (95% CI, 0.17-0.51). Receipt of auto-HCT was not associated with OS (HR, 0.69; 95% CI, 0.41-1.16; P = .16) but was associated with MIPI intermediate (HR, 5.7; 95% CI, 2.5-13.2; P < .01) and high (HR, 10.8; 95% CI, 4.7-24.9; P < .01) scores. We report outcomes in a large cohort of patients with blastoid/pleomorphic variant MCL. For eligible patients, receipt of auto-HCT after induction was associated with improved PFS but not OS. Higher MIPI score and auto-HCT ineligibility were associated with worse survival.
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Affiliation(s)
- James N. Gerson
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Handorf
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer, Vancouver, CA
| | | | - Parv Chapani
- BC Cancer Centre for Lymphoid Cancer, Vancouver, CA
| | | | | | | | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Michael Churnetski
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | | | | | | | | | | | - Martin Bast
- University of Nebraska Cancer Center, Omaha, NE
| | - Timothy Fenske
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - David Bond
- Division of Hematology, Ohio State University, Columbus, OH
| | - Veronika Bachanova
- Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | - Bhaskar Kolla
- Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | | | | | | | - Timothy Burns
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - Marcus Messmer
- Hematologic Malignancies Division, Johns Hopkins University, Baltimore, MD
| | | | | | | | | | - Daniel J. Landsburg
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Kay Ristow
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Reem Karmali
- Division of Hematology and Oncology, Northwestern University, Evanston, IL
| | - Jason B. Kaplan
- Division of Hematology and Oncology, Northwestern University, Evanston, IL
| | - Paolo F. Caimi
- Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH
| | - Saurabh Rajguru
- Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, WI
| | - Andrew Evens
- Division of Hematology/Oncology, Tufts University, Boston, MA
| | - Andreas Klein
- Division of Hematology/Oncology, Tufts University, Boston, MA
| | - Elvira Umyarova
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | - Bhargavi Pulluri
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | | | - Jennifer K. Lue
- Division of Hematology and Oncology, Columbia University, New York, NY
| | | | - Richard I. Fisher
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Stefan K. Barta
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
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Waidyaratne G, Bennett C, Umyarova E, Bumma N. Extensive Intracardiac Cement Embolism in a Patient Undergoing Workup for Bone Marrow Transplant. J Hematol 2023; 12:283-286. [PMID: 38188473 PMCID: PMC10769642 DOI: 10.14740/jh1202] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/25/2023] [Indexed: 01/09/2024] Open
Abstract
Cement emboli are a well-established complication of kyphoplasties and vertebroplasties and can easily be mistaken for wires. While kyphoplasties are commonly performed for vertebral fractures caused by metastases from malignancies such as multiple myeloma, the implication of cement emboli in bone marrow transplant (BMT) patients is not well documented. Our patient presented with an incidental intracardiac cement embolism found while undergoing workup for BMT. He was managed conservatively, but transplant workup was put on hold until the embolism could be removed due to the risks associated with cement emboli. The significance of cement emboli in immunocompromised patients needs to be further investigated.
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Affiliation(s)
- Gavisha Waidyaratne
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Caitlin Bennett
- Department of Hospice and Palliative Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Elvira Umyarova
- Division of Hematology and Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Naresh Bumma
- Division of Hematology and Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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3
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Khan AM, Dvorak K, Zhao Q, Bumma N, Cottini F, Devarakonda S, Umyarova E, Sharma N, Benson D, Rosko A. Modified carfilzomib dosing is associated with improved treatment responses and longer time on treatment in patients with multiple myeloma. Haematologica 2023; 108:3477-3479. [PMID: 37439332 PMCID: PMC10690893 DOI: 10.3324/haematol.2022.282521] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/30/2023] [Indexed: 07/14/2023] Open
Abstract
Not available.
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Affiliation(s)
- Abdullah M Khan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210.
| | - Kiatlyn Dvorak
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Naresh Bumma
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Francesca Cottini
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Srinivas Devarakonda
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Elvira Umyarova
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Nidhi Sharma
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Don Benson
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Ashley Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
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4
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Ozga M, Zhao Q, Huric L, Miller C, Rosko A, Khan A, Umyarova E, Benson D, Cottini F. Concomitant 1q+ and t(4;14) influences disease characteristics, immune system, and prognosis in double-hit multiple myeloma. Blood Cancer J 2023; 13:167. [PMID: 37949844 PMCID: PMC10638414 DOI: 10.1038/s41408-023-00943-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Michael Ozga
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Qiuhong Zhao
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Laila Huric
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Cecelia Miller
- The Ohio State University Comprehensive Cancer Center, Department of Pathology, Columbus, OH, USA
| | - Ashley Rosko
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Abdullah Khan
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Elvira Umyarova
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Don Benson
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA
| | - Francesca Cottini
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology, Columbus, OH, USA.
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Epperla N, Zhao Q, Karmali R, Torka P, Shea L, Oh TS, Anampa-Guzmán A, Reves H, Tavakkoli M, Greenwell IB, Hansinger E, Umyarova E, Annunzio K, Sawalha Y, Christian B, Thomas C, Barta SK, Geethakumari PR, Bartlett NL, Grover NS, Olszewski AJ. Impact of detectable monoclonal protein at diagnosis on outcomes in marginal zone lymphoma: a multicenter cohort study. Blood Adv 2023; 7:5038-5046. [PMID: 37315169 PMCID: PMC10471932 DOI: 10.1182/bloodadvances.2023010133] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/06/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
Given the paucity of data surrounding the prognostic relevance of monoclonal paraprotein (M-protein) in marginal zone lymphoma (MZL), we sought to evaluate the impact of detecting M-protein at diagnosis on outcomes in patients with MZL in a large retrospective cohort. The study included 547 patients receiving first-line therapy for MZL. M-protein was detectable at diagnosis in 173 (32%) patients. There was no significant difference in the time from diagnosis to initiation of any therapy (systemic and local) between the M-protein and no M-protein groups. Patients with M-protein at diagnosis had significantly inferior progression-free survival (PFS) compared with those without M-protein at diagnosis. After adjusting for factors associated with inferior PFS in univariate models, presence of M-protein remained significantly associated with inferior PFS (hazard ratio, 1.74; 95% confidence interval, 1.20-2.54; P = .004). We observed no significant difference in the PFS based on the type or quantity of M-protein at diagnosis. There were differential outcomes in PFS based on the first-line therapy in patients with M-protein at diagnosis, in that, those receiving immunochemotherapy had better outcomes compared with those receiving rituximab monotherapy. The cumulative incidence of relapse in stage 1 disease among the recipients of local therapy was higher in the presence of M-protein; however, this did not reach statistical significance. We found that M-protein at diagnosis was associated with a higher risk of histologic transformation. Because the PFS difference related to presence of M-protein was not observed in patients receiving bendamustine and rituximab, immunochemotherapy may be a preferred approach over rituximab monotherapy in this group and needs to be explored further.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Qiuhong Zhao
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Reem Karmali
- Department of Medicine, Northwestern University, Chicago, IL
| | - Pallawi Torka
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lauren Shea
- Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Timothy S. Oh
- Department of Medicine, Northwestern University, Chicago, IL
| | | | - Heather Reves
- Department of Medicine, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Montreh Tavakkoli
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Irl Brian Greenwell
- Department of Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Emily Hansinger
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Elvira Umyarova
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
- Department of Medicine, University of Vermont, Burlington, VT
| | - Kaitlin Annunzio
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Yazeed Sawalha
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Beth Christian
- Division of Hematology, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Colin Thomas
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Stefan K. Barta
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Nancy L. Bartlett
- Department of Medicine, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Natalie S. Grover
- Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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6
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Bao A, Zhao Q, Kudalkar R, Rodriguez J, Sharma N, Bumma N, Devarakonda SS, Khan AM, Umyarova E, Rosko AE, Benson D, Cottini F. Impact of interval progression before autologous stem cell transplant in patients with multiple myeloma. Front Oncol 2023; 13:1216461. [PMID: 37554170 PMCID: PMC10405820 DOI: 10.3389/fonc.2023.1216461] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/28/2023] [Indexed: 08/10/2023] Open
Abstract
In transplant-eligible patients who undergo upfront autologous stem cell transplant (ASCT) for multiple myeloma (MM), standard practice is to treat with six to eight cycles of induction therapy followed by high-dose chemotherapy with ASCT. A gap between the end of induction and the day of ASCT exists to allow stem cell mobilization and collection. Despite attempts to limit the length of this interval, we noticed that some patients experience interval progression (IP) of disease between the end of induction therapy and the day of ASCT. We analyzed 408 MM patients who underwent ASCT between 2011 and 2016. The median length of the interval between end of induction and ASCT was 38 days. We observed that 26% of patients in the entire cohort and 23.6% of patients who received induction with bortezomib-lenalidomide-dexamethasone (VRD) experienced IP. These patients deepened their responses with ASCT, independently of induction regimen. In the entire cohort, IP was significantly associated with shorter PFS in the univariable analysis (Hazard Ratio, HR = 1.37, P = 0.022) but not in the multivariable analysis (HR = 1.14, P = 0.44). However, analyzing only patients who received VRD as induction, progression-free survival (PFS) remained inferior in both the univariable (HR = 2.02; P = 0.002) and the multivariable analyses (HR = 1.96; P = 0.01). T cells and natural killer (NK) cells are increasingly studied targets of immunomodulatory therapy, as immune dysfunction is known to occur in patients with MM. Peripheral blood from 35 MM patients were analyzed. At time of ASCT, patients with IP had significantly increased percentages of CD3+CD8+CD57+ CD28- (P = 0.05) and CD3+CD4+LAG3+ (P = 0.0022) T-cells, as well as less CD56bright and CD56dim NK cells bearing activated markers such as CD69, NKG2D, and CD226. These data suggest that IP can impact the length of response to ASCT; therefore, further studies on the management of these patients are needed.
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Affiliation(s)
- Alicia Bao
- The Ohio State University, College of Medicine, Columbus, OH, United States
| | - Qiuhong Zhao
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ruchi Kudalkar
- The Ohio State University, College of Medicine, Columbus, OH, United States
| | - Jose Rodriguez
- The Ohio State University, College of Medicine, Columbus, OH, United States
- School of Medicine, Ponce Health Science University, Ponce, Puerto Rico
| | - Nidhi Sharma
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Naresh Bumma
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Srinivas S. Devarakonda
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Abdullah M. Khan
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Elvira Umyarova
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ashley E. Rosko
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Don Benson
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Francesca Cottini
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, United States
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7
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Sharma N, Benson E, Zhao Q, Nunnelee J, Cottini F, Elder P, Rosko A, Bumma N, Khan A, Umyarova E, Devarakonda S, Efebera YA, Benson DM. Survival outcomes following autologous stem cell transplant with melphalan 140mg/m 2 versus 200mg/m 2 preparative regimens in patients with multiple myeloma. Leuk Lymphoma 2023; 64:1315-1321. [PMID: 37199099 DOI: 10.1080/10428194.2023.2213366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Abstract
The standard preparative regimen for autologous stem cell transplant (ASCT) in multiple myeloma (MM) is 200 mg/m2 of intravenous melphalan; however, a dose of 140 mg/m2 is often used when concerns exist related to patient age, performance status, organ function, and other factors. It is unclear whether a lower dose of melphalan impacts post-transplant survival outcomes. We performed a retrospective review of 930 patients with MM who underwent ASCT with 200 mg/m2 versus 140 mg/m2 melphalan. On univariable analysis, no difference in progression-free survival (PFS) was observed, however, an overall survival (OS) benefit was observed in patients receiving 200 mg/m2 melphalan (p = 0.04). Multivariable analyses showed patients receiving 140 mg/m2 faired no worse than those receiving 200 mg/m2. While a subset of younger patients with normal renal function may achieve superior OS with a standard dose of 200 mg/m2 melphalan, these findings suggest an opportunity to individualize the ASCT preparative regimen to optimize outcomes.
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Affiliation(s)
- Nidhi Sharma
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Evan Benson
- Pre-Medical Program, University of Dayton, Dayton, OH, USA
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Jordan Nunnelee
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Francesca Cottini
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Patrick Elder
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ashley Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Naresh Bumma
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Abdullah Khan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Elvira Umyarova
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Srinivas Devarakonda
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Yvonne A Efebera
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Don M Benson
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Bone Marrow Transplantation & Cellular Therapy, OhioHealth, Columbus, OH, USA
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8
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Khan AM, Ozga M, Bhatt H, Faisal MS, Ansari S, Zhao Q, Bumma N, Cottini F, Devarakonda S, Rosko A, Sharma N, Umyarova E, Benson D. Outcomes After Salvage Autologous Hematopoietic Cell Transplant for Patients With Relapsed/Refractory Multiple Myeloma: A Single-Institution Experience. Clin Lymphoma Myeloma Leuk 2023; 23:e182-e189. [PMID: 36581554 DOI: 10.1016/j.clml.2022.12.001] [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] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of salvage autologous hematopoietic cell transplantation (sAHCT2) for patients with relapsed/refractory multiple myeloma (RRMM) in the era of modern therapeutics is unclear. As prospective data is limited, we conducted a retrospective analysis to determine the outcomes of sAHCT2. PATIENTS AND METHODS We conducted a single-institution, retrospective analysis of patients who received sAHCT2 at The Ohio State University from 2000 to 2018. Patients who received a second transplant as part of a planned tandem or autologous-allogeneic transplant were excluded. RESULTS Fifty-seven patients were treated with sAHCT2. Patients had a median of 2 lines of therapy after AHCT1 prior to their sAHCT2; 70% had prior immunomodulatory imide drugs, 82% had prior proteasome inhibitor, and 20% had prior anti-CD38 monoclonal antibodies as part of re-induction therapy. Forty-two percent of patients attained ≥VGPR prior to sAHCT2. Seventy-four were treated with melphalan 200 mg/m2 as conditioning regimen before infusion of a median of 3.8 × 106 CD34+ cells/kg. Fifty-eight percent patients had maintenance therapy and 81% patients attained CR/VGPR as the best response after sAHCT2. The median PFS and OS after sAHCT2 were 1.6 and 3.6 years, respectively. On multivariable analysis, high-risk cytogenetics, not having attained CR/VGPR, and having more than 2 lines of therapy post-AHCT1 were associated with inferior PFS. Melphalan 140 mg/m2 compared to melphalan 200 mg/m2 and no maintenance therapy compared to maintenance therapy were not associated with inferior PFS. There was no transplant-related mortality in this patient cohort. CONCLUSIONS For MM patients deriving durable remission after their AHCT1, sAHCT2 was safe and resulted in deep and durable remissions.
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Affiliation(s)
- Abdullah M Khan
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Michael Ozga
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Harshil Bhatt
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Muhammad S Faisal
- Roswell Park Comprehensive Cancer Center, Division of Hematology, Rochester, NY
| | - Sadia Ansari
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Qiuhong Zhao
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Naresh Bumma
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Francesca Cottini
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Srinivas Devarakonda
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ashley Rosko
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nidhi Sharma
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Elvira Umyarova
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Don Benson
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
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9
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Khan AM, Yucebay F, Zhao Q, Umyarova E, Cottini F, Bumma N, Rosko A, Benson D, Sharma N, Efebera Y, Devarakonda S. Comparison of Patient Outcomes With Two Different Formulations of Melphalan as Conditioning Chemotherapy for Autologous Hematopoietic Cell Transplantation in Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2023; 23:e85-e96. [PMID: 36411211 DOI: 10.1016/j.clml.2022.10.004] [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] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND High-dose melphalan (HDM) with autologous hematopoietic cell transplantation (AHCT) after induction chemotherapy is considered standard of care in transplant-eligible patients with newly-diagnosed multiple myeloma (MM). Alkeran melphalan has propylene glycol as a solvent (PG-mel) while Evomela utilizes a propylene glyclol-free formulation (PGF-mel). We evaluated the differences in efficacy and safety of the 2 formulations as there are no prospective head-to-head trials. METHODS We retrospectively reviewed the medical records of all 259 consecutive MM patients who received PGF-mel as part of HDM-AHCT at The Ohio State University (OSU). The comparator group was the preceding 255 patients who received PG-mel. RESULTS Baseline patient characteristics were similar between the 2 groups. Post-AHCT rates of relapse were comparable in the PG-mel and PGF-mel groups. Some adverse events were observed at a higher frequency in the PG-mel group compared to the PGF-mel group (grade ≥ 2 mucositis, febrile neutropenia, other infectious complications, and acute renal insufficiency). Time to neutrophil engraftment was slightly longer in the PG-mel group while time to platelet engraftment was longer in PGF-mel group. Red cell transfusion requirement was higher with the use of PG-mel but not platelet transfusion. Duration of hospitalization was slightly shorter with PGF-mel but readmission rates within 30 days of discharge were higher. CONCLUSION Considering possible confounding factors could possibly account for observed differences in some adverse events, the comparable treatment responses, and difference in cost of the 2 formulation, The OSU reverted to PG-mel as the preferred formulation for HDM-AHCT in MM.
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Affiliation(s)
- Abdullah M Khan
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Filiz Yucebay
- College of Pharmacy, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Elvira Umyarova
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Francesca Cottini
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Naresh Bumma
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ashley Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Don Benson
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nidhi Sharma
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Srinivas Devarakonda
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH.
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Epperla N, Zhao Q, Chowdhury SM, Shea L, Moyo TK, Reddy N, Sheets J, Weiner DM, Geethakumari PR, Kandarpa M, Bruno XJ, Thomas C, Churnetski MC, Hsu A, Zurbriggen L, Tan XWC, Lindsey K, Maakaron J, Caimi PF, Torka P, Bello C, Ayyappan S, Oh TS, Karmali R, Kim SH, Kress A, Kothari S, Sawalha Y, Christian B, David KA, Greenwell IB, Janakiram M, Kenkre VP, Olszewski AJ, Cohen JB, Palmisiano N, Umyarova E, Wilcox RA, Awan FT, Alderuccio JP, Barta SK, Grover NS, Ghosh N, Bartlett NL, Herrera AF, Shouse G. Postibrutinib relapse outcomes for patients with marginal zone lymphoma. Blood Adv 2023; 7:88-91. [PMID: 36269847 PMCID: PMC9827027 DOI: 10.1182/bloodadvances.2022008634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/07/2022] [Accepted: 09/24/2022] [Indexed: 01/18/2023] Open
Affiliation(s)
- Narendranath Epperla
- Division of Hematology, The Ohio State University, Columbus, OH
- Correspondence: Narendranath Epperla, Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH 43210;
| | - Qiuhong Zhao
- Division of Hematology, The Ohio State University, Columbus, OH
| | | | - Lauren Shea
- Division of Hematology, Washington University, St. Louis, MO
| | | | | | - Julia Sheets
- Division of Hematology and Oncology, University of North Carolina, Chapel Hill, NC
| | - David M. Weiner
- Division of Hematology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Malathi Kandarpa
- Division of Hematology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | | | - Colin Thomas
- Division of Hematology, Thomas Jefferson University, Philadelphia, PA
| | | | - Andrew Hsu
- Division of Hematology, Brown University, Providence, RI
| | - Luke Zurbriggen
- Division of Hematology, University of Wisconsin, Madison, WI
| | | | - Kathryn Lindsey
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC
| | - Joseph Maakaron
- Division of Hematology, University of Minnesota, Minneapolis, MN
| | - Paolo F. Caimi
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Pallawi Torka
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Celeste Bello
- Division of Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Sabarish Ayyappan
- Division of Hematology and Oncology, University of Iowa, Iowa City, IA
| | - Timothy S. Oh
- Division of Hematology, Northwestern University, Chicago, IL
| | - Reem Karmali
- Division of Hematology, Northwestern University, Chicago, IL
| | - Seo-Hyun Kim
- Division of Hematology and Oncology, Rush University, Chicago, IL
| | - Anna Kress
- Division of Hematology, Yale University, New Haven, CT
| | | | - Yazeed Sawalha
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Beth Christian
- Division of Hematology, The Ohio State University, Columbus, OH
| | | | - Irl Brian Greenwell
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC
| | - Murali Janakiram
- Division of Hematology, University of Minnesota, Minneapolis, MN
| | | | | | - Jonathon B. Cohen
- Winship Cancer Institute, Emory University Medical Center, Atlanta, GA
| | - Neil Palmisiano
- Division of Hematology, Thomas Jefferson University, Philadelphia, PA
| | - Elvira Umyarova
- Division of Hematology and Oncology, University of Vermont, Burlington, VT
| | - Ryan A. Wilcox
- Division of Hematology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Farrukh T. Awan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Stefan K. Barta
- Division of Hematology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Natalie S. Grover
- Division of Hematology and Oncology, University of North Carolina, Chapel Hill, NC
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11
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Bao A, Zhao Q, Merritt E, Bumma N, Devarakonda S, Khan AM, Umyarova E, Rosko AE, Benson DM, Cottini F. Racial differences as predictors of outcomes in young patients with multiple myeloma. Blood Cancer J 2022; 12:114. [PMID: 35896527 PMCID: PMC9329432 DOI: 10.1038/s41408-022-00708-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Alicia Bao
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Qiuhong Zhao
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Naresh Bumma
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Srinivas Devarakonda
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Abdullah M Khan
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Elvira Umyarova
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ashley E Rosko
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Don M Benson
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Francesca Cottini
- Department of Internal Medicine, Division of Hematology, College of Medicine, The Ohio State University, Columbus, OH, USA.
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12
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Epperla N, Zhao Q, Chowdhury SM, Shea L, Moyo TK, Reddy N, Sheets J, Weiner DM, Geethakumari PR, Kandarpa M, Bruno XJ, Thomas C, Churnetski MC, Hsu A, Zurbriggen L, Tan C, Lindsey K, Maakaron J, Caimi PF, Torka P, Bello C, Ayyappan S, Karmali R, Kim SH, Kress A, Kothari S, Sawalha Y, Christian B, David KA, Greenwell IB, Janakiram M, Kenkre VP, Olszewski AJ, Cohen JB, Palmisiano N, Umyarova E, Wilcox RA, Awan FT, Alderuccio JP, Barta SK, Grover NS, Ghosh N, Bartlett NL, Herrera AF, Shouse G. Predictive factors and outcomes for ibrutinib in relapsed/refractory marginal zone lymphoma: a multicenter cohort study. J Hematol Oncol 2022; 15:96. [PMID: 35842643 PMCID: PMC9287914 DOI: 10.1186/s13045-022-01316-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Ibrutinib is effective in the treatment of relapsed/refractory (R/R) marginal zone lymphoma (MZL) with an overall response rate (ORR) of 48%. However, factors associated with response (or lack thereof) to ibrutinib in R/R MZL in clinical practice are largely unknown. To answer this question, we performed a multicenter (25 US centers) cohort study and divided the study population into three groups: "ibrutinib responders"-patients who achieved complete or partial response (CR/PR) to ibrutinib; "stable disease (SD)"; and "primary progressors (PP)"-patients with progression of disease as their best response to ibrutinib. One hundred and nineteen patients met the eligibility criteria with 58%/17% ORR/CR, 29% with SD, and 13% with PP. The median PFS and OS were 29 and 71.4 months, respectively, with no difference in PFS or OS based on the ibrutinib line of therapy or type of therapy before ibrutinib. Patients with complex cytogenetics had an inferior PFS (HR = 3.08, 95% CI 1.23-7.67, p = 0.02), while those with both complex cytogenetics (HR = 3.00, 95% CI 1.03-8.68, p = 0.04) and PP (HR = 13.94, 95% CI 5.17-37.62, p < 0.001) had inferior OS. Only primary refractory disease to first-line therapy predicted a higher probability of PP to ibrutinib (RR = 3.77, 95% CI 1.15-12.33, p = 0.03). In this largest study to date evaluating outcomes of R/R MZL treated with ibrutinib, we show that patients with primary refractory disease and those with PP on ibrutinib are very high-risk subsets and need to be prioritized for experimental therapies.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Qiuhong Zhao
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Sayan Mullick Chowdhury
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | | | - Tamara K Moyo
- Levine Cancer Center, Atrium Health, Charlotte, NC, USA
| | - Nishitha Reddy
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julia Sheets
- University of North Carolina, Chapel Hill, NC, USA
| | - David M Weiner
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Colin Thomas
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Cherie Tan
- Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | - Paolo F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | | | - Celeste Bello
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | | | | | | | - Yazeed Sawalha
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Beth Christian
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Kevin A David
- Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | | | | | - Jonathon B Cohen
- Winship Cancer Institute, Emory University Medical Center, Atlanta, GA, USA
| | | | | | - Ryan A Wilcox
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Farrukh T Awan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Stefan K Barta
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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13
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Karmali R, Donovan A, Wagner‐Johntson N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Ristow K, Lansigan F, Kaplan JB, Caimi PB, Rajguru S, Evens A, Klein A, Umyarova E, Amengual JE, Lue JK, Diefenbach C, Epperla N, Barta SK, Hernandez‐Ilizaliturri FJ, Handorf E, Villa D, Gerrie AS, Li S, Mederios J, Wang M, Cohen J, Calzada O, Churnetski M, Hill B, Sawalha Y, Gerson JN, Kothari S, Vose JM, Bast M, Fenske TS, Narayana Rao Gari S, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B. SURVIVAL FOLLOWING FIRST RELAPSE IN YOUNGER PATIENTS WITH MANTLE CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.60_2880] [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: 11/12/2022]
Affiliation(s)
| | - A. Donovan
- Dartmouth Hitchcock, Hem Onc Lebanon USA
| | | | - M. Messmer
- Johns Hopkins University, Hem Onc Baltimore USA
| | - A. Mehta
- University of Alabama Cancer Center, Hem Onc Birmingham USA
| | - J. K. Anderson
- University of Alabama Cancer Center, Hem Onc Birmingham USA
| | - N. Reddy
- Vanderbilt Ingram Cancer Center, Hem Onc Nashville USA
| | - A. E. Kovach
- Vanderbilt Ingram Cancer Center, Hem Onc Nashville USA
| | - D. J. Landsburg
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | - M. Glenn
- Huntsman Cancer Institute, Hem Onc Salt Lake City USA
| | | | | | | | | | - P. B. Caimi
- Case Western Reserve University, Hem Onc Cleveland USA
| | - S. Rajguru
- University of Wisconsin, Hem Onc Madison USA
| | - A. Evens
- Rutgers, Hem Onc New Brunswick USA
| | | | - E. Umyarova
- University of Vermont, Hem Onc Burlington USA
| | | | | | | | - N. Epperla
- Ohio State University, Hem Onc Columbus USA
| | - S. K. Barta
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | | | - E. Handorf
- Fox Chase Cancer Center, Hematology Oncology Philadelphia USA
| | - D. Villa
- BC Cancer, Hem Onc Vancouver Canada
| | | | - S. Li
- MD Anderson, Hem Onc Houstin USA
| | | | - M. Wang
- MD Anderson, Hem Onc Houstin USA
| | | | | | | | | | | | - J. N. Gerson
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | | | - J. M. Vose
- University of Nebraska Cancer Center, Hem Onc Omaha USA
| | - M. Bast
- University of Nebraska Cancer Center, Hem Onc Omaha USA
| | - T. S. Fenske
- Medical College of Wisconsin, Hem Onc Milwaukee USA
| | | | | | - D. Bond
- Ohio State University, Hem Onc Columbus USA
| | - V. Bachanova
- University of Minnesota , Hem Onc Minneapolis USA
| | - B. Kolla
- University of Minnesota , Hem Onc Minneapolis USA
| | - J. Chavez
- Moffitt Cancer Center, Hem Onc Tampa USA
| | - B. Shah
- Moffitt Cancer Center, Hem Onc Tampa USA
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14
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Cornell R, Hari P, Tang S, Biran N, Callander N, Chari A, Chhabra S, Fiala MA, Gahvari Z, Gandhi U, Godby K, Gupta R, Jagannath S, Jagosky M, Kang Y, Kansagra A, Kauffman M, Kodali S, Kumar SK, Lakshman A, Liedtke M, Lonial S, Ma X, Malek E, Mansour J, McGehee EF, Neppalli A, Paul B, Richardson P, Scott EC, Shacham S, Shah J, Siegel DS, Umyarova E, Usmani SZ, Varnado W, Vij R, Costa L. Overall survival of patients with triple-class refractory multiple myeloma treated with selinexor plus dexamethasone vs standard of care in MAMMOTH. Am J Hematol 2021; 96:E5-E8. [PMID: 32974944 DOI: 10.1002/ajh.26010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Robert Cornell
- Vanderbilt University Medical Center Nashville, Tennessee
| | | | - Shijie Tang
- Karyopharm Therapeutics Inc Newton, Massachusetts
| | - Noa Biran
- John Theurer Cancer Center Hackensack University Hackensack, New Jersey
| | | | - Ajai Chari
- Mount Sinai School of Medicine New York, New York
| | | | - Mark A. Fiala
- Washington University School of Medicine St. Louis, Missouri
| | | | | | - Kelly Godby
- University of Alabama at Birmingham Birmingham, Alabama
| | - Ridhi Gupta
- Stanford University School of Medicine Stanford, California
| | | | - Megan Jagosky
- Levine Cancer Institute/Atrium Health Charlotte, North Carolina
| | - Yubin Kang
- Duke University School of Medicine Durham, North Carolina
| | - Ankit Kansagra
- University of Texas Southwestern Medical Center Dallas, Texas
| | | | - Saranya Kodali
- University of Vermont, College of Medicine Burlington, Vermont
| | | | - Arjun Lakshman
- Department of Internal Medicine University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | | | | | - Xiwen Ma
- Karyopharm Therapeutics Inc Newton, Massachusetts
| | - Ehsan Malek
- Case Western Reserve University Cleveland, Ohio
| | - Joshua Mansour
- City of Hope Comprehensive Center Duarte, California
- Kaiser Permanente Medical Group Los Angeles, California
| | | | | | - Barry Paul
- Levine Cancer Institute/Atrium Health Charlotte, North Carolina
| | - Paul Richardson
- Medical Oncology, Dana‐Farber Cancer Institute Harvard Medical School Boston, Massachusetts
| | | | | | - Jatin Shah
- Karyopharm Therapeutics Inc Newton, Massachusetts
| | - David S. Siegel
- John Theurer Cancer Center Hackensack University Medical Center Hackensack, New Jersey
| | - Elvira Umyarova
- University of Vermont, College of Medicine Burlington, Vermont
| | - Saad Z. Usmani
- Levine Cancer Institute/Atrium Health Charlotte, North Carolina
| | | | - Ravi Vij
- Washington University School of Medicine St. Louis, Missouri
| | - Luciano Costa
- University of Alabama at Birmingham Birmingham, Alabama
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15
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Khan S, Landry K, Umyarova E. Caplacizumab treatment for acquired refractory thrombotic thrombocytopenic purpura. Br J Haematol 2020; 191:e44-e46. [DOI: 10.1111/bjh.16977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Sundas Khan
- Department of Internal Medicine University of Vermont Medical Center Burlington VT USA
| | - Kara Landry
- Department of Hematology and Oncology University of Vermont Medical Center Burlington VT USA
| | - Elvira Umyarova
- Department of Hematology and Oncology University of Vermont Medical Center Burlington VT USA
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16
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Umyarova E, Adapa S, Naramala S, Gayam V, Aeddula NR, Konala VM. A Rare Manifestation of a Rare Disease: Mantle Cell Lymphoma Presenting With Aseptic Meningitis. J Investig Med High Impact Case Rep 2019; 7:2324709619858643. [PMID: 31234647 PMCID: PMC6593924 DOI: 10.1177/2324709619858643] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a rare form of non-Hodgkin lymphoma characterized by clonal proliferation of follicular mantle zone B lymphocytes. It is caused by abnormal chromosomal translocation t(11;14) resulting in aberrant expression of cyclin D1. This leads to activation of anti-apoptotic pathways and abnormal proliferation of MCL cells. Patients can present with an indolent course or a fulminant disease with short overall survival. The disease frequently involves extranodal organs, but rarely manifests with neurological symptoms. We report a rare case of aberrant CD5-negative MCL presenting with aseptic meningitis.
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Affiliation(s)
| | | | | | - Vijay Gayam
- 4 Interfaith Medical Center, Brooklyn, NY, USA
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17
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Gerson JN, Handorf E, Villa D, Gerrie AS, Chapani P, Li S, Medeiros LJ, Wang MI, Cohen JB, Calzada O, Churnetski MC, Hill BT, Sawalha Y, Hernandez-Ilizaliturri FJ, Kothari S, Vose JM, Bast MA, Fenske TS, Narayana Rao Gari S, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B, Lansigan F, Burns TF, Donovan AM, Wagner-Johnston N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Karmali R, Kaplan JB, Caimi PF, Rajguru S, Evens A, Klein A, Umyarova E, Pulluri B, Amengual JE, Lue JK, Diefenbach C, Fisher RI, Barta SK. Survival Outcomes of Younger Patients With Mantle Cell Lymphoma Treated in the Rituximab Era. J Clin Oncol 2019; 37:471-480. [PMID: 30615550 DOI: 10.1200/jco.18.00690] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Mantle cell lymphoma (MCL) is a B-cell lymphoma characterized by cyclin D1 expression. Autologous hematopoietic cell transplantation (AHCT) consolidation after induction chemotherapy is often used for eligible patients; however, the benefit remains uncertain in the rituximab era. Herein we retrospectively assessed the impact of AHCT consolidation on survival in a large cohort of transplantation-eligible patients age 65 years or younger. PATIENTS AND METHODS We retrospectively studied transplantation-eligible adults age 65 years or younger with newly diagnosed MCL treated between 2000 and 2015. The primary objective was to assess for improved progression-free survival (PFS) with AHCT consolidation and secondarily to assess for improved overall survival (OS). Cox multivariable regression analysis and propensity score-weighted (PSW) analysis were performed. RESULTS Data were collected from 25 medical centers for 1,254 patients; 1,029 met inclusion criteria. Median follow-up for the cohort was 76 months. Median PFS and OS were 62 and 139 months, respectively. On unadjusted analysis, AHCT was associated with improved PFS (75 v 44 months with v without AHCT, respectively; P < .01) and OS (147 v 115 months with v without AHCT, respectively; P < .05). On multivariable regression analysis, AHCT was associated with improved PFS (hazard ratio [HR], 0.54; 95% CI, 0.44 to 0.66; P < .01) and a trend toward improved OS (HR, 0.77; 95% CI, 0.59 to 1.01; P = .06). After PSW analysis, AHCT remained associated with improved PFS (HR, 0.70; 95% CI, 0.59 to 0.84; P < .05) but not improved OS (HR, 0.87; 95% CI, 0.69 to 1.1; P = .2). CONCLUSION In this large cohort of younger, transplantation-eligible patients with MCL, AHCT consolidation after induction was associated with significantly improved PFS but not OS after PSW analysis. Within the limitations of a retrospective analysis, our findings suggest that in younger, fit patients, AHCT consolidation may improve PFS.
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Affiliation(s)
| | | | - Diego Villa
- 2 BC Cancer, Vancouver, British Columbia, Canada
| | | | - Parv Chapani
- 2 BC Cancer, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Julie M Vose
- 7 University of Nebraska Cancer Center, Omaha, NE
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martha Glenn
- 17 Huntsman Cancer Institute, Salt Lake City, UT
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18
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Badar T, Hamadani M, Bachanova V, Maddocks KJ, Umyarova E, Chavez JC, Epperla N, Chhabra S, Xavier AC, Karmali R, Salhab M, Reddy N, Glenn MJ, Hernandez-Ilizaliturri FJ, Flowers CR, Evens AM, Zhou Z, Lansigan F, Barta SK, Cohen JB, Fenske TS, Costa LJ. Efficacy of salvage chemotherapy in diffuse large B cell lymphoma with primary treatment failure according to putative cell of origin. Leuk Lymphoma 2018; 60:940-946. [PMID: 30277110 DOI: 10.1080/10428194.2018.1515944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We evaluated outcome of 235 primary treatment failure (PTF) diffuse large B-cell lymphoma (DLBCL) patients based on salvage chemotherapy regimen and putative cell-of-origin (COO). Patients were divided into two groups; group A (n = 38) received high-dose cytarabine containing regimen, either DHAP or ESHAP. Patients in group B (n = 197) received ifosfamide, carboplatin, and etoposide (ICE) +/- rituximab. No difference in overall response rates (CR + PR) was observed based on salvage chemotherapy regimen and COO. After adjustment for the presence of ultra high-risk features, overall survival of germinal center B-cell like (GCB) DLBCL patients in group A was not significantly different from survival in group B (HR 0.86, 95% CI 0.46-1.60, p = .64). Similarly, within non-GCB DLBCL cohort, survival in group A was comparable to group B (HR 0.53, 95% CI 0.20-1.44, p = .21). We did not find an outcome difference between two commonly used salvage chemotherapy regimens in patients with PTF DLBCL based on COO.
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Affiliation(s)
- Talha Badar
- a Division of Hematology and Oncology , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Mehdi Hamadani
- a Division of Hematology and Oncology , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Veronika Bachanova
- b Department of Medicine, Division of Hematology, Oncology and Transplantation , University of Minnesota , Minneapolis , MN , USA
| | - Kami J Maddocks
- c Division of Hematology, Department of Internal Medicine , The James Cancer Hospital and Solove Research Institute at The Ohio State University , Columbus , OH , USA
| | - Elvira Umyarova
- d Division of Hematology and Oncology , University of Vermont Cancer Center , Burlington , VT , USA
| | - Julio C Chavez
- e Division of Malignant Hematology , H. Lee Moffitt Cancer Center & Research Institute , Tampa , FL , USA
| | - Narendranath Epperla
- c Division of Hematology, Department of Internal Medicine , The James Cancer Hospital and Solove Research Institute at The Ohio State University , Columbus , OH , USA
| | - Saurabh Chhabra
- a Division of Hematology and Oncology , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Ana C Xavier
- f Dept. of Pediatrics , University of Alabama , Birmingham , AL , USA
| | - Reem Karmali
- g Department of Internal Medicine , Rush University , Chicago , IL , USA
| | - Mohammed Salhab
- h Division of Hematology and Oncology , UMASS Memorial Medical Center , Worcestor , MA , USA
| | - Nishitha Reddy
- i Division of Hematology and Oncology , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Martha J Glenn
- j Department of Internal Medicine , Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
| | | | - Christopher R Flowers
- l Department of Hematology and Medical Oncology , Winship Cancer Institute, Emory University , Atlanta , GA , USA
| | - Andrew M Evens
- m Division of Hematology and Oncology , Tufts University School of Medicine and Cancer Center , Boston , MA , USA
| | - Zheng Zhou
- n Department of Hematology and Oncology , City of hope , Los angeles , CA , USA
| | | | - Stefan K Barta
- p Department of Hematology and Oncology , Fox Chase Cancer Center, Temple Health , Philadelphia , PA , USA
| | - Jonathon B Cohen
- l Department of Hematology and Medical Oncology , Winship Cancer Institute, Emory University , Atlanta , GA , USA
| | - Timothy S Fenske
- a Division of Hematology and Oncology , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Luciano J Costa
- q Department of Medicine , University of Alabama , Birmingham , AL , USA
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Epperla N, Maddocks KJ, Salhab M, Chavez JC, Reddy N, Karmali R, Umyarova E, Bachanova V, Costa C, Glenn M, Calzada O, Xavier AC, Zhou Z, Hossain NM, Hernandez-Ilizaliturri FJ, Al-Mansour Z, Barta SK, Chhabra S, Lansigan F, Mehta A, Jaglal MV, Evens AM, Flowers CR, Cohen JB, Fenske TS, Hamadani M, Costa LJ. C-MYC-positive relapsed and refractory, diffuse large B-cell lymphoma: Impact of additional "hits" and outcomes with subsequent therapy. Cancer 2017; 123:4411-4418. [PMID: 28749548 DOI: 10.1002/cncr.30895] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/12/2017] [Accepted: 06/27/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of MYC proto-oncogene, basic helix-loop-helix (MYC) translocations (with or without additional rearrangements involving the B-cell lymphoma 2 [BCL2] or BCL6 genes) on the response to salvage therapy and survival in patients with diffuse large B-cell lymphoma (DLBCL) who experience primary treatment failure is not well defined. METHODS This was a multicenter, retrospective study of the impact of MYC, BCL2, and BCL6 rearrangements in patients with DLBCL who failed to achieve complete remission or relapsed within 6 months after they completed upfront chemoimmunotherapy. RESULTS The authors examined response to salvage therapy, receipt of hematopoietic cell transplantation (HCT), and survival outcomes in MYC-negative (n = 120), MYC-positive single hit (SH) (n = 20), and MYC-positive double hit/triple hit (DH/TH) (n = 35) cohorts. The overall response rate in these cohorts to first salvage therapy (51%, 50%, and 54%, respectively) and receipt of HCT (52%, 40%, and 43%, respectively) were comparable between the 3 cohorts. The 2-year overall survival rate was 29.9% in the MYC-negative cohort, 0% in the MYC-positive SH cohort, and 9.9% in the MYC-positive DH/TH cohort (P < .001), and no difference was observed between the SH and DH/TH cohorts (P = .8). The higher risk of death for patients with MYC-positive SH DLBCL (hazard ratio, 1.70; 95% confidence interval, 0.98-2.96; P = .06) and those with MYC-positive DH/TH DLBCL (hazard ratio, 2.22; 95% confidence interval, 1.41-3.50; P = .001) persisted after adjusting for covariates. For patients who underwent autologous HCT, the 2-year overall survival rate was 55.4% in the MYC-negative cohort, 0% in the MYC-positive SH cohort, and 19.4% in the MYC-positive DH/TH cohort (P < .001). All 4 MYC-positive patients who underwent allogeneic HCT relapsed in <4 months. CONCLUSIONS Patients with MYC-positive DLBCL who experience primary treatment failure have response rates to similar to those achieved by salvage therapy compared with their MYC-negative counterparts, but their survival is dismal irrespective of additional "hits" and HCT, representing an unmet medical need. Cancer 2017;123:4411-8. © 2017 American Cancer Society.
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Affiliation(s)
- Narendranath Epperla
- Department of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kami J Maddocks
- Department of Hematology, Ohio State University, Columbus, Ohio
| | - Mohammed Salhab
- Children's Medical Center, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Nishitha Reddy
- Department of Hematology/Oncology, Vanderbilt University, Nashville, Tennessee
| | - Reem Karmali
- Department of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, Illinois
| | - Elvira Umyarova
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplant, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | | | - Martha Glenn
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Oscar Calzada
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Ana C Xavier
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Zheng Zhou
- Children's Medical Center, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | | | | | - Zeina Al-Mansour
- Section of Hematology and Oncology, Department of Medicine, Tufts University Medical Center, Boston, Massachusetts
| | | | - Saurabh Chhabra
- Department of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Frederick Lansigan
- Department of Hematology Oncology, Darmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Amitkumar Mehta
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael V Jaglal
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Andrew M Evens
- Section of Hematology and Oncology, Department of Medicine, Tufts University Medical Center, Boston, Massachusetts
| | | | | | - Timothy S Fenske
- Department of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Department of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Luciano J Costa
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama
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Epperla N, Maddocks KJ, Salhab M, Chavez JC, Reddy NM, Karmali R, Umyarova E, Bachanova V, Glenn MJ, Xavier AC, Zhou Z, Hernandez-Ilizaliturri FJ, Barta SK, Lansigan F, Mehta AN, Flowers C, Cohen JB, Fenske TS, Hamadani M, Costa LJ. MYC+ relapsed and refractory (R/R) diffuse large b-cell lymphoma (DLBCL): Impact of additional hits and outcomes with subsequent therapy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7541 Background: Translocations involving MYC are a hallmark of poor prognosis among patients with newly diagnosed DLBCL. The impact of MYC translocations with or without additional “hits” involving BCL2 or BCL6 in response to salvage therapy and survival in R/R DLCBL is not well defined. Methods: We performed a multicenter retrospective study of 176 patients with R/R DLBCL failing to achieve CR or relapsing within 6 months after completion of upfront chemoimmunotherapy and for whom FISH information on MYC, BCL2 and BCL6 was available. The objectives were to examine the response to salvage therapy, utilization of hematopoietic cell transplantation (HCT) and survival outcomes in MYC- (n = 120), MYC+ single hit (SH, n = 28), and MYC+ double hit (DH, n = 36) R/R DLBCL. Results: Overall response rate to first salvage therapy and utilization of HCT was comparable between the 3 cohorts (Table). 2-year OS was 0% in MYC+ SH, 8.8% in MYC+ DH and 29.9% in MYC- cases (p = 0.001) without difference in OS between SH and DH (P = 0.8). The higher risk of death for MYC+ SH (HR 1.79, 95% C.I. 1.03-3.11, P = 0.03) and MYC+ DH (HR 1.93, 95% C.I. 1.23-3.00, P = 0.004) persisted after adjustment for covariates. For patients who underwent auto-HCT, 2-year OS was 0% in MYC+ SH, 29.3% in MYC+ DH and 55.4% in MYC- cases (p < 0.001) without significant difference between SH and DH (P = 0.8). All 4 MYC+patients who underwent allo-HCT relapsed in < 4 months. Conclusions: MYC+ R/R DLBCL have similar response to salvage therapy than the MYC- counterparts but dismal survival irrespective of additional “hits” and even if HCT can be performed. MYC+ R/R DLBCL represents an unmet medical need and should be prioritized for clinical trials with novel agents and innovative cellular therapies. [Table: see text]
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Affiliation(s)
| | - Kami J. Maddocks
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Mohamed Salhab
- University of Massachusetts Memorial Medical Center, Worcester, MA
| | - Julio C. Chavez
- H. Lee Moffitt Cancer Canter and Research Institute, Tampa, FL
| | | | | | | | | | - Martha Jane Glenn
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | | | - Zheng Zhou
- University of Massachusetts Memorial Medical Center, Worcester, MA
| | | | | | | | | | | | | | | | - Mehdi Hamadani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Costa LJ, Maddocks K, Epperla N, Reddy NM, Karmali R, Umyarova E, Bachanova V, Costa C, Glenn MJ, Chavez JC, Calzada O, Lansigan F, Nasheed H, Barta SK, Zhou Z, Jaglal M, Chhabra S, Hernandez-Ilizaliturri F, Xavier AC, Mehta A, Peker D, Forero-Torres A, Al-Mansour Z, Evens AM, Cohen JB, Flowers CR, Fenske TS, Hamadani M. Diffuse large B-cell lymphoma with primary treatment failure: Ultra-high risk features and benchmarking for experimental therapies. Am J Hematol 2017; 92:161-170. [PMID: 27880984 DOI: 10.1002/ajh.24615] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 01/02/2023]
Abstract
The outcomes of patients with DLBCL and primary treatment failure (PTF) in the rituximab era are unclear. We analyzed 331 patients with PTF, defined as primary progression while on upfront chemoimmunotherapy (PP), residual disease at the end of upfront therapy (RD) or relapse < 6 months from end of therapy (early relapse; ER). Median age was 58 years and response to salvage was 41.7%. Two-year OS was 18.5% in PP, 30.6% in RD and 45.5% in ER. The presence of PP, intermediate-high/high NCCN-IPI at time of PTF or MYC translocation predicted 2-year OS of 13.6% constituting ultra-high risk (UHR) features. Among the 132 patients who underwent autologous hematopoietic cell transplantation, 2-year OS was 74.3%, 59.6% and 10.7% for patients with 0,1 and 2-3 UHR features respectively. Patients with PTF and UHR features should be prioritized for clinical trials with newer agents and innovative cellular therapy.
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Affiliation(s)
- Luciano J. Costa
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Kami Maddocks
- Division of Hematology; Ohio state University; Columbus Ohio USA
| | - Narendranath Epperla
- Division of Hematology and Oncology; Medical College of Wisconsin; Milwaukee Wisconsin USA
| | - Nishitha M. Reddy
- Division of Hematology and Oncology; Vanderbilt University; Nashville Tennessee USA
| | - Reem Karmali
- Division of Hematology, Oncology and Cell Therapy; Rush University; Chicago Illinois USA
| | - Elvira Umyarova
- Division of Hematology and Oncology; Medical University of South Carolina; Charleston South Carolina USA
| | - Veronika Bachanova
- Division of Hematology; Oncology and Transplantation, University of Minnesota; Minneapolis Minnesota USA
| | - Cristiana Costa
- Department of Hematology and Oncology; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire USA
| | - Martha J. Glenn
- Division of Hematology and Hematologic Malignancies; University of Utah; Salt Lake City Utah USA
| | - Julio C. Chavez
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center and Research; Tampa Florida USA
| | - Oscar Calzada
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta Georgia USA
| | - Frederick Lansigan
- Department of Hematology and Oncology; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire USA
| | - Hossain Nasheed
- Department of Hematology/Oncology; Fox Chase Cancer Center; Philadelphia Pennsylvania USA
| | - Stefan K. Barta
- Department of Hematology/Oncology; Fox Chase Cancer Center; Philadelphia Pennsylvania USA
| | - Zheng Zhou
- Division of Hematology-Oncology; University of Massachusetts; Worcester Massachusetts USA
| | - Michael Jaglal
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center and Research; Tampa Florida USA
| | - Saurabh Chhabra
- Division of Hematology and Oncology; Medical University of South Carolina; Charleston South Carolina USA
| | | | - Ana C. Xavier
- Department of Pediatrics; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Amitkumar Mehta
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Deniz Peker
- Department of Pathology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Andreas Forero-Torres
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Zeina Al-Mansour
- Division of Hematology/Oncology; Tufts University; Boston Massachusetts USA
| | - Andrew M. Evens
- Division of Hematology/Oncology; Tufts University; Boston Massachusetts USA
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta Georgia USA
| | - Christopher R. Flowers
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta Georgia USA
| | - Timothy S. Fenske
- Division of Hematology and Oncology; Medical College of Wisconsin; Milwaukee Wisconsin USA
| | - Mehdi Hamadani
- Division of Hematology and Oncology; Medical College of Wisconsin; Milwaukee Wisconsin USA
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Umyarova E, Chhabra S, Mims A, Stuart R, Costa LJ. Anti CD20 Radioimmunotherapy and mTOR Inhibition in Reduced Intensity Conditioning Hematopoietic Stem Cell Transplantation for Relapsed/Refractory B Cell Lymphomas. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.504] [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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Panikkath R, Suvorava N, Ngo N, Panikkath D, Lim SY, Umyarova E, Meyerrose G. Comparison of patients rehospitalized for heart failure with versus without a history of habitual alcohol consumption. Proc (Bayl Univ Med Cent) 2014; 27:208-9. [PMID: 24982560 DOI: 10.1080/08998280.2014.11929109] [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: 10/18/2022] Open
Abstract
Alcohol paradoxically is known to have a protective and a deleterious effect on the heart. The effect of alcoholism on the growing problem of heart failure (HF) readmissions is not known. This study addressed this issue with a population of adult patients (>20 years old) who were readmitted for HF within 30 days after a hospitalization for HF at a university hospital in West Texas for a period of 5 years. Of the 204 patients with HF who were readmitted, 130 were admitted for HF exacerbations and 74 for unrelated medical conditions. Seventy-two (55%) were men, and the patients' mean age was 67 ± 15 years. Only 32 patients (24%) had a history of alcoholism. The mean age was significantly lower in patients with a history of alcoholism than in those without (62 ± 11 vs. 67 ± 15 years; P = 0.03), and there were more men in the group with a history of alcoholism (78% vs. 52%; P = 0.006). The mean ejection fraction was significantly lower in patients with a history of alcoholism than in those without (35 ± 19% vs. 39 ± 16%, P = 0.04). The length of stay was slightly longer in patients with a history of alcoholism, although the difference was not statistically significant (6 ± 5 vs. 5 ± 4 days; P = 0.52). Although alcohol contributed to only less than one quarter of hospital admissions, these patients were relatively younger and were predominantly males, compared to the sex-matched distribution of patients without a history of alcoholism.
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Affiliation(s)
- Ragesh Panikkath
- Department of Internal Medicine and Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Natalia Suvorava
- Department of Internal Medicine and Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Neena Ngo
- Department of Internal Medicine and Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Deepa Panikkath
- Department of Internal Medicine and Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Sian Yik Lim
- Department of Internal Medicine and Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Elvira Umyarova
- Department of Internal Medicine and Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Gary Meyerrose
- Department of Internal Medicine and Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas
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Panikkath R, Konala V, Panikkath D, Umyarova E, Hardwicke F. Fatal Clostridium septicum infection in a patient with a hematological malignancy. Proc (Bayl Univ Med Cent) 2014; 27:111-2. [PMID: 24688190 DOI: 10.1080/08998280.2014.11929074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A 49-year-old woman with acute myeloid transformation of myelodysplastic syndrome was admitted with mild erythema and pain in the right thigh and left forearm. She was doing well and had been discharged the previous day after consolidation chemotherapy. Examination showed only mild erythema and tenderness of the right thigh. She was started on broad-spectrum antibiotics. Discoloration progressed rapidly, and within hours the right femoral and left brachial pulses were not palpable. She was taken to the operating room for a suspicion of embolic arterial occlusion. Surgical incision, however, revealed extensive necrosis of the tissues with the presence of gas. Her relatives did not want her to undergo amputation. The patient developed refractory hypotension and died within 15 hours of presentation. Blood samples later tested positive for Clostridium septicum. This case is presented to create awareness about the subtle presentation and rapid progression of this infection, which can lead to death in less than 24 hours.
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Affiliation(s)
- Ragesh Panikkath
- Departments of Internal Medicine and Oncology, Texas Tech University Health Sciences Center-School of Medicine, Lubbock, Texas
| | - Venu Konala
- Departments of Internal Medicine and Oncology, Texas Tech University Health Sciences Center-School of Medicine, Lubbock, Texas
| | - Deepa Panikkath
- Departments of Internal Medicine and Oncology, Texas Tech University Health Sciences Center-School of Medicine, Lubbock, Texas
| | - Elvira Umyarova
- Departments of Internal Medicine and Oncology, Texas Tech University Health Sciences Center-School of Medicine, Lubbock, Texas
| | - Fred Hardwicke
- Departments of Internal Medicine and Oncology, Texas Tech University Health Sciences Center-School of Medicine, Lubbock, Texas
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Nantsupawat T, Ono C, Umyarova E, Mankongpaisarnrung C, Panikkath R, Arvandi A, Perez-Verdia A, Bunag T, Meyerrose G. Effects of Alcohol and Illicit Substance Consumption in Patients with Infective Endocarditis. Alcoholism Treatment Quarterly 2013. [DOI: 10.1080/07347324.2013.749148] [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]
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Cerdan-Trevino M, Umyarova E, Maa E, Nugent K. Sudden unexpected death in epilepsy. Neurol Clin Pract 2012; 2:356-358. [DOI: 10.1212/cpj.0b013e318278be52] [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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