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Alvarnas JC, Brown PA, Aoun P, Ballen KK, Barta SK, Borate U, Boyer MW, Burke PW, Cassaday R, Castro JE, Coccia PF, Coutre SE, Damon LE, DeAngelo DJ, Douer D, Frankfurt O, Greer JP, Johnson RA, Kantarjian HM, Klisovic RB, Kupfer G, Litzow M, Liu A, Rao AV, Shah B, Uy GL, Wang ES, Zelenetz AD, Gregory K, Smith C. Acute Lymphoblastic Leukemia, Version 2.2015. J Natl Compr Canc Netw 2016; 13:1240-79. [PMID: 26483064 DOI: 10.6004/jnccn.2015.0153] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/17/2022]
Abstract
Treatment of acute lymphoblastic leukemia (ALL) continues to advance, as evidenced by the improved risk stratification of patients and development of newer treatment options. Identification of ALL subtypes based on immunophenotyping and cytogenetic and molecular markers has resulted in the inclusion of Philadelphia-like ALL and early T-cell precursor ALL as subtypes that affect prognosis. Identification of Ikaros mutations has also emerged as a prognostic factor. In addition to improved prognostication, treatment options for patients with ALL have expanded, particularly with regard to relapsed/refractory ALL. Continued development of second-generation tyrosine kinase inhibitors and the emergence of immunotherapy, including blinatumomab and chimeric antigen receptor T-cell therapy, have improved survival. Furthermore, incorporation of minimal residual disease (MRD) monitoring has shown insight into patient outcomes and may lead to treatment modification or alternative treatment strategies in select populations. This excerpt focuses on the sections of the ALL guidelines specific to clinical presentation and diagnosis, treatment of relapsed/refractory ALL, and incorporation of MRD monitoring. To view the most recent complete version of these guidelines, visit NCCN.org.
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Alvarnas JC, Linn YC, Hope EG, Negrin RS. Expansion of cytotoxic CD3+ CD56+ cells from peripheral blood progenitor cells of patients undergoing autologous hematopoietic cell transplantation. Biol Blood Marrow Transplant 2001; 7:216-22. [PMID: 11349808 DOI: 10.1053/bbmt.2001.v7.pm11349808] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 12/12/2022]
Abstract
Immunotherapy may potentially improve the outcome of autologous hematopoietic cell transplantation (HCT). Poor effector cell proliferation and marginal antitumor activity limit attempts to use immunotherapy. We have characterized the ex vivo expansion, up to 1000-fold, of CD3+ CD56+ lymphocytes from the peripheral blood lymphocytes (PBL) of healthy donors. Expanded cells termed cytokine-induced killer (CIK) cells induce non-major histocompatibility complex-restricted lysis of tumor cells and demonstrate cytolytic activity superior to lymphokine-activated killer cells without the requirement of interleukin (IL)-2 treatment in vivo. To determine whether cytolytic cells could be expanded from patient material, we evaluated samples of peripheral blood progenitor cells (PBPCs) from 25 patients undergoing autologous HCT. The PBPCs were expanded by priming with interferon-gamma followed by anti-CD3 monoclonal antibody and IL-2 the next day. Fluorescence-activated cell sorting analysis was performed on days 0, 15, 21, and 28 of cell culture. The median T-cell content rose from 15.3% (range, 1.1% to 89.7%) on day 0 to 97.2% (range, 83.6% to 99.5%) by day 15. By day 21, T cells expanded 21.8-fold (range, 1.7- to 420.0-fold) and CD3+ CD56+ cells expanded 44.8-fold (range, 5.1- to 747.0-fold). CIK cells were used as effector cells against B-cell lymphoma targets (OCI-Ly8) with a median of 24% (range, 3% to 67%) and 42% (range, 6% to 96%) specific lysis of target cells on days 21 and 28, respectively. CIK cells derived from PBL of 2 additional patients with acute myelogenous leukemia demonstrated 39% and 78% specific lysis of OCI-Ly8 and 26% and 58% specific lysis of autologous leukemic blasts at an effector:target ratio of 40:1. CIK cells may be expanded from granulocyte colony-stimulating factor-mobilized PBPCs of patients undergoing autologous HCT. CIK cells may provide a potent tool for use in posttransplantation adoptive immunotherapy.
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MESH Headings
- Acute Disease
- Adult
- Aged
- CD3 Complex/analysis
- CD56 Antigen/analysis
- Cells, Cultured/drug effects
- Cells, Cultured/transplantation
- Combined Modality Therapy
- Cytotoxicity, Immunologic
- Female
- Granulocyte Colony-Stimulating Factor/pharmacology
- Hematopoietic Stem Cell Mobilization
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunophenotyping
- Immunotherapy, Adoptive
- Interferon-gamma/pharmacology
- Interleukin-2/pharmacology
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Killer Cells, Natural/transplantation
- Leukemia, Myeloid/blood
- Leukemia, Myeloid/immunology
- Leukemia, Myeloid/therapy
- Male
- Middle Aged
- Muromonab-CD3/pharmacology
- Neoplasms/immunology
- Neoplasms/therapy
- Neoplastic Stem Cells/immunology
- Transplantation, Autologous
- Treatment Outcome
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Alvarnas JC, Brown PA, Aoun P, Ballen KK, Bellam N, Blum W, Boyer MW, Carraway HE, Coccia PF, Coutre SE, Cultrera J, Damon LE, DeAngelo DJ, Douer D, Frangoul H, Frankfurt O, Goorha S, Millenson MM, O'Brien S, Petersdorf SH, Rao AV, Terezakis S, Uy G, Wetzler M, Zelenetz AD, Naganuma M, Gregory KM. Acute lymphoblastic leukemia. J Natl Compr Canc Netw 2012; 10:858-914. [PMID: 22773801 DOI: 10.6004/jnccn.2012.0089] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 02/03/2023]
Abstract
The inaugural NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for acute lymphoblastic leukemia (ALL) were developed as a result of meetings convened by a multi-disciplinary panel of experts in 2011. These NCCN Guidelines provide recommendations on the diagnostic evaluation and workup for ALL, risk assessment, risk-stratified treatment approaches based on the Philadelphia chromosome status and age (adults vs. adolescents/young adults), assessment of minimal residual disease, and supportive care considerations. It is recommended that patients be treated at specialized centers with expertise in the management of ALL.
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Alvarnas JC, Negrin RS, Horning SJ, Hu WW, Long GD, Schriber JR, Stockerl-Goldstein K, Tierney K, Wong R, Blume KG, Chao NJ. High-dose therapy with hematopoietic cell transplantation for patients with central nervous system involvement by non-Hodgkin's lymphoma. Biol Blood Marrow Transplant 2001; 6:352-8. [PMID: 10905773 DOI: 10.1016/s1083-8791(00)70060-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/20/2022]
Abstract
Central nervous system (CNS) involvement by non-Hodgkin's lymphoma (NHL) carries a poor patient prognosis whether it occurs as a primary site of disease or secondarily in patients with systemic disease. In a group of 481 patients undergoing high-dose therapy with hematopoietic cell transplantation (HCT) for NHL, 15 patients (3.1%) were identified with CNS involvement. Two patients had primary CNS lymphoma, and 13 had secondary disease. All patients received intrathecal chemotherapy, and 13 received CNS radiotherapy before transplantation. Fourteen patients received systemic chemotherapy. At the time of transplantation, both patients with primary CNS lymphoma and 8 patients with secondary disease had achieved a complete response, 3 patients had achieved a partial response, 1 had failed induction therapy, and 1 had progression of CNS disease before high-dose therapy. Fourteen patients received carmustine, etoposide, and cyclophosphamide as the preparative regimen, and 1 patient received fractionated total body irradiation instead of carmustine. The 2 patients with primary CNS lymphoma were alive and free of disease, 1 at 1,085 days after HCT and 1 at 3,704 days after HCT. The actuarial 5-year event-free survival (EFS) was 46% +/- 26%, and overall survival (OS) was 41% +/- 28%. The median EFS and OS were 2.2 and 1.5 years, respectively. Three patients experienced symptomatic memory loss or intellectual decline after therapy, 1 patient developed paraplegia, and 1 patient had a thrombotic stroke 20 months after HCT. Despite treatment-related toxicities, 7 patients responding to quality-of-life questions at approximately 1 year after HCT gave their overall quality of life a median rating of 9 out of a possible 10 (range, 6-10). High-dose therapy with autologous HCT can produce extended EFS in patients with secondary CNS lymphoma and possibly in those with primary CNS NHL.
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Ambinder RF, Wu J, Logan B, Durand CM, Shields R, Popat UR, Little RF, McMahon DK, Cyktor J, Mellors JW, Ayala E, Kaplan LD, Noy A, Jones RJ, Howard A, Forman SJ, Porter D, Arce-Lara C, Shaughnessy P, Sproat L, Hashmi SK, Mendizabal AM, Horowitz MM, Navarro WH, Alvarnas JC. Allogeneic Hematopoietic Cell Transplant for HIV Patients with Hematologic Malignancies: The BMT CTN-0903/AMC-080 Trial. Biol Blood Marrow Transplant 2019; 25:2160-2166. [PMID: 31279752 PMCID: PMC6907401 DOI: 10.1016/j.bbmt.2019.06.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/31/2019] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
We set out to assess feasibility and safety of allogeneic hematopoietic cell transplant in 17 persons with HIV in a phase II prospective multicenter trial. The primary endpoint was 100-day nonrelapse mortality (NRM). Patients had an 8/8 HLA-matched related or at least a 7/8 HLA-matched unrelated donor. Indications for transplant were acute leukemia, myelodysplasia, and lymphoma. Conditioning was myeloablative or reduced intensity. There was no NRM at 100 days. The cumulative incidence of grades II to IV acute graft-versus-host disease (GVHD) was 41%. At 1 year, overall survival was 59%; deaths were from relapsed/progressive disease (n = 5), acute GVHD (n = 1), adult respiratory distress syndrome (n = 1), and liver failure (n = 1). In patients who achieved complete chimerism, cell-associated HIV DNA and inducible infectious virus in the blood were not detectable. Blood and Marrow Transplant Clinical Trials Network 0903/AIDS Malignancy Consortium 080 was registered at www.clinicaltrials.gov (no. NCT01410344).
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Clinical Trial, Phase II |
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Nardi EA, Wolfson JA, Rosen ST, Diasio RB, Gerson SL, Parker BA, Alvarnas JC, Levine HA, Fong Y, Weisenburger DD, Fitzgerald CL, Egan M, Stranford S, Carlson RW, Benz EJ. Value, Access, and Cost of Cancer Care Delivery at Academic Cancer Centers. J Natl Compr Canc Netw 2017; 14:837-47. [PMID: 27407124 DOI: 10.6004/jnccn.2016.0088] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/16/2016] [Accepted: 05/24/2016] [Indexed: 11/17/2022]
Abstract
Key challenges facing the oncology community today include access to appropriate, high quality, patient-centered cancer care; defining and delivering high-value care; and rising costs. The National Comprehensive Cancer Network convened a Work Group composed of NCCN Member Institution cancer center directors and their delegates to examine the challenges of access, high costs, and defining and demonstrating value at the academic cancer centers. The group identified key challenges and possible solutions to addressing these issues. The findings and recommendations of the Work Group were then presented at the Value, Access, and Cost of Cancer Care Policy Summit in September 2015 and multi-stakeholder roundtable panel discussions explored these findings and recommendations along with additional items.
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Ambinder RF, Wu J, Logan B, Durand C, Shields R, Popat UR, Little RF, Mcmahon D, Mellors JW, Ayala E, Kaplan LD, Noy A, Howard A, Forman SJ, Mendizabal AM, Horowitz MM, Navarro WH, Alvarnas JC. Allogeneic hematopoietic cell transplant (alloHCT) for hematologic malignancies in human immunodeficiency virus infected (HIV) patients (pts): Blood and Marrow Transplant Clinical Trials Network (BMT CTN 0903)/AIDS Malignancy Consortium (AMC-080) trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/20/2022] Open
Abstract
7006 Background: AlloHCT has been regarded as risky in HIV pts, with concern about fatal infection. We set out to assess feasibility and safety of alloHCT in this first prospective multicenter trial. Methods: The primary endpoint was 100-day non-relapse mortality (NRM). Pts had drug-susceptible HIV; age ≥ 15 yr; adequate organ function; acute myeloid leukemia (AML) or acute lymphocytic leukemia (ALL), high risk myelodysplastic syndrome (MDS), or Hodgkin (HL) or non-Hodgkin lymphoma (NHL) beyond first CR; an 8/8 HLA-matched related or at least a 7/8 unrelated donor. Pts received myeloablative (MA) or reduced intensity (RI) regimens. HIV outgrowth assays (VOA) were performed with resting CD4+T-cells in pts who had clinically undetectable HIV plasma RNA at 1 yr. Results: Between 5/2012 and 12/2015, 17 pts underwent alloHCT. Pts were: male (17); white (11), African American (3), Other/Unknown (3); median age 47 yrs (25-64). Associated malignancies were AML (9), ALL (2), MDS (2), HL (1), NHL (3). Median CD4 was 224 (55-833). Conditioning was MA (8) and RI (9). At 100 days there was no NRM, 13 pts were in CR, 4 pts had relapsed/progressive disease; and 8 pts achieved complete chimerism. The cumulative incidence of Grades (Gr) II-IV acute Graft vs Host Disease (GvHD) was 41 % (95%CI: 18 %, 64%). At 6 mo, OS was 82 % (95% confidence interval [CI]: 55%, 94%); 9 pts achieved complete chimerism. At 1 year, OS was 57 % (CI: 31%, 77 %); 8 deaths were from relapsed/progressive disease (5), acute GvHD (1), adult respiratory distress syndrome (1) and liver failure (1). Infections were reported in 11 pts (3 Gr 2, 8 Gr 3). Infectious HIV was detected by VOA in 2 of 3 pts who were mixed chimeras but 0 of 2 who were 100% donor. Median follow up of survivors is 24 mo (7 to 27 ). Conclusions: HIV pts with heme malignancies underwent MA or RI alloHCT without any100-day NRM and there were no infectious deaths at 1 year. AlloHCT should be considered the standard of care for HIV pts who meet usual eligibility criteria. Clinical trial information: NCT01410344.
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Zachariah F, Emanuel L, Ito-Hammerling G, Wong-Toh J, Morse D, Klein L, Loscalzo MJ, Garcia N, Buga S, Lew M, Horak D, Banerjee C, Mooney S, Alvarnas JC. The effects of global and targeted advance care planning efforts at a national comprehensive cancer center. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.5_suppl.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/20/2022] Open
Abstract
79 Background: Advance Care Planning is a central component of patient centered care and helps assure treatment aligns with a patient’s goals, values, and priorities. Various studies demonstrate advance care planning decreases stress and anxiety, increases satisfaction, improves awareness and implementation of a patient’s end of life wishes, and reduces costs in select populations. At City of Hope (COH) National Medical Center, we made concerted efforts over the last four years to improve the overall number of advance directives(ADs), and have additionally focused on improving AD capture rates in clinically relevant populations (patients undergoing surgery, those with metastatic disease, and those undergoing hematologic transplant). Methods: The Department of Supportive Care Medicine with executive team endorsement and in collaboration with medical oncology, hematology, anesthesia, surgery, nursing, marketing, and informatics created a patient-centric advance care planning program. We developed disease specific workflows, created multi-lingual AD workshops in the Sheri & Les Biller Patient and Family Resource Center, changed policy to provide complimentary patient/caregiver and staff notarizations for ADs, leveraged the electronic medical record (assured providers were able to document discussions, know when ADs were absent, and easily retrieve ADs when present), deploy AD specific screening questions, and most recently created a culturally sensitive branding campaign coined “Plan Today for Tomorrow.” Results: The rate of advance directive capture for all patients new to COH has continuously improved from 12% in 2012 to 22% in 2016. In transplant patients, AD capture rate increased to 63%. In a pilot for bladder cancer patients undergoing cystectomy, ADs were increased to 68%, and in the pre-anesthesia testing clinic, ADs were increased to 35%. Conclusions: We have made significant strides in the capture of advance directives at City of Hope with markedly higher capture rates in selectively targeted, clinically relevant populations. We anticipate improved patient centric care as a result, with the unintended consequence of cost savings and decreased resource utilization.
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Shindiapina P, Pietrzak M, Seweryn M, McLaughlin E, Zhang X, Makowski M, Ahmed EH, Schlotter S, Pearson R, Kitzler R, Mozhenkova A, Le-Rademacher J, Little RF, Akpek G, Ayala E, Devine SM, Kaplan LD, Noy A, Popat UR, Hsu JW, Morris LE, Mendizabal AM, Krishnan A, Wachsman W, Williams N, Sharma N, Hofmeister CC, Forman SJ, Navarro WH, Alvarnas JC, Ambinder RF, Lozanski G, Baiocchi RA. Immune Recovery Following Autologous Hematopoietic Stem Cell Transplantation in HIV-Related Lymphoma Patients on the BMT CTN 0803/AMC 071 Trial. Front Immunol 2021; 12:700045. [PMID: 34539628 PMCID: PMC8446430 DOI: 10.3389/fimmu.2021.700045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/25/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
We report a first in-depth comparison of immune reconstitution in patients with HIV-related lymphoma following autologous hematopoietic cell transplant (AHCT) recipients (n=37, lymphoma, BEAM conditioning), HIV(-) AHCT recipients (n=30, myeloma, melphalan conditioning) at 56, 180, and 365 days post-AHCT, and 71 healthy control subjects. Principal component analysis showed that immune cell composition in HIV(+) and HIV(-) AHCT recipients clustered away from healthy controls and from each other at each time point, but approached healthy controls over time. Unsupervised feature importance score analysis identified activated T cells, cytotoxic memory and effector T cells [higher in HIV(+)], and naïve and memory T helper cells [lower HIV(+)] as a having a significant impact on differences between HIV(+) AHCT recipient and healthy control lymphocyte composition (p<0.0033). HIV(+) AHCT recipients also demonstrated lower median absolute numbers of activated B cells and lower NK cell sub-populations, compared to healthy controls (p<0.0033) and HIV(-) AHCT recipients (p<0.006). HIV(+) patient T cells showed robust IFNγ production in response to HIV and EBV recall antigens. Overall, HIV(+) AHCT recipients, but not HIV(-) AHCT recipients, exhibited reconstitution of pro-inflammatory immune profiling that was consistent with that seen in patients with chronic HIV infection treated with antiretroviral regimens. Our results further support the use of AHCT in HIV(+) individuals with relapsed/refractory lymphoma.
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Research Support, N.I.H., Extramural |
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Zachariah F, Popplewell L, Forman SJ, Gorospe G, Wong-Toh J, Morse D, Emanuel L, Ito-Hamerling G, Garcia N, Horak D, Kassouny D, Ohanesian P, Buga S, Dale W, Mooney S, Tegtmeier B, Banerjee C, Patel P, Alvarnas JC. The advance directive completion rates in the hematopoietic stem cell transplant population in a major transplant cancer center. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.31_suppl.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/20/2022] Open
Abstract
16 Background: Advance Care Planning (ACP) is central to patient-centered care and helps assure treatment aligns with a patient’s goals, values, and priorities. ACP is often poorly incorporated into the hematopoietic stem cell transplantation (HSCT) population, with reported advance directive (AD) rates of 23-50%. At City of Hope National Medical Center (COH), concerted efforts to improve the overall number of ADs in HSCT was undertaken and evaluated. Methods: The Department of Supportive Care Medicine at COH, in collaboration with medical faculty and administrative support, created a patient-centered ACP program. The first two years (2013/2014) broadly focused on all new COH patients. The last two years (2015/2016) included a specific focus on patients undergoing HSCT. The primary goal was a completed AD in the electronic medical record before day 0 of transplant. In addition to provider and transplant team engagement, major time points for supportive care integration to facilitate AD completion were identified including: 1) registration, 2) new patient orientation, 3) the clinical visit when transplant was decided, 4) pre-transplant education class, 5) clinical social work psychosocial assessment visit, and 6) the pre-transplant hospital days. AD completion rates were calculated with Odds Ratio and Mantel-Haenszel Chi-Square using Epi Info StatCalc. Results: Between 2012 and 2016 at COH, 1784 transplants were performed. For HSCT patients in 2012, baseline AD capture rate before day 0 of transplant was 28.6%. With the institutional AD program, the AD capture rate before day 0 of transplant was 31.6% for 2014, compared with 2012 [odds ratio, 1.17(95% CI, 0.85-1.60); p = .33]. With both institutional and hematology specific programs, AD capture rate before day 0 was 69.5% for 2016, compared to 2014[odds ratio, 4.30 (95% CI, 3.14-5.91); p < .001]. Conclusions: Compared to 2012, the institutional AD program in 2014 insignificantly impacted HSCT AD completion rates. Improving the rate of AD completion from 28.6% to 69.5% in HSCT patients required both institutional AD efforts and a targeted program. Nevertheless, more work is needed to improve AD completion rates before transplant to 100%.
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Brown PA, Alvarnas JC. Reaping the Benefits of Recent Advances for Adults With Acute Lymphoblastic Leukemia. J Natl Compr Canc Netw 2012; 10:800-1. [DOI: 10.6004/jnccn.2012.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/17/2022]
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Shindiapina P, Pietrzak M, Seweryn M, McLaughlin E, Zhang X, Makowski M, Lyberger J, Chang H, Ahmed E, Pearson R, Kitzler R, Le-Rademacher JG, Little RF, Akpek G, Ayala E, Devine SM, Kaplan LD, Noy A, Popat UR, Hsu JW, Morris LE, Mendizabal A, Krishnan A, Hofmeister CC, Forman SJ, Navarro WH, Alvarnas JC, Ambinder RF, Behbehani G, Lozanski G, Baiocchi R. Comparative Analysis of Immune Reconstitution in HIV-Positive Recipients of Allogeneic and Autologous Stem Cell Transplant on the BMT-CTN-0903/AMC-080 and BMT-CTN-0803/AMC-071 Trials. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/30/2022]
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Alvarnas JC, Avanessian P, Wakabayashi MT, Kassab T, Levine AM. City of Hope's referring physician communication process improvement initiative. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.31_suppl.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/20/2022] Open
Abstract
63 Background: City of Hope’s (COH) Performance Excellence Program (PEP), a physician incentive program aimed at improving quality and process outcomes, identified the need to establish a process for strengthening COH’s relationship with referring physicians. Methods: Working in collaboration with New Patient Services, Marketing, and physicians across multiple disciplines, we implemented a manual process of copying information in all H and Ps/Admit Notes, discharge summaries, consultation notes, and operative reports to referring MDs if the COH MD had not done so. The PEP team is also in the process of establishing a specific COH referral MD line that would allow for priority queuing and a real-time warm transfer to the MD/ MD’s office. Marketing of the number will be conducted through a standard thank-you cover letter sent by every COH MD upon initial consultation of patient, as well as through a newly revamped physician website. The implementation of a Health Information Exchange is also in progress. Results: Overall satisfaction on COHs ability to communicate increased from 23% to 30%. Number of 10 or more updates received from COH increased from 0% to 17%. Those who referred 20% of their patient volume increased from 15% to 20% while those who only referred 1-5% decreased from 69% to 30%. Conclusions: Through the multiple strategies and joint efforts across disciplines, COH has strengthened its relationship with referring MDs and increased its referral volume. [Table: see text]
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Alvarnas JC, Brown PA. Advances in the Care of Adult Patients With Acute Lymphoblastic Leukemia: Optimism Tempered by Reality. J Natl Compr Canc Netw 2016; 14:815-7. [PMID: 27407121 DOI: 10.6004/jnccn.2016.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/17/2022]
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Alvarnas JC, Vanderplas A, Zain J. Autologous vs Allogeneic Hematopoietic Cell Transplantation for Patients With Peripheral T-cell Lymphomas-Closer, Yet Still So Far to Go. JAMA Netw Open 2021; 4:e2111674. [PMID: 34042998 DOI: 10.1001/jamanetworkopen.2021.11674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/14/2022] Open
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Alvarnas JC, Forman SJ. Graft purging in autologous bone marrow transplantation: a promise not quite fulfilled. ONCOLOGY (WILLISTON PARK, N.Y.) 2004; 18:867-76; discussion 876-8, 881, 884. [PMID: 15255171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Academic Contribution Register] [Indexed: 04/30/2023]
Abstract
Clonogenic tumor cells contained within hematopoietic stem cell (HPC) grafts may contribute to relapse following autologous transplantation. Graft purging involves either in vivo or ex vivo HPC manipulation in order to reduce the level of tumor cell contamination. Some phase II trials suggest that patients who receive purged products may have a superior transplant outcome. Phase I trials demonstrate the feasibility of purging methods including ex vivo graft incubation with chemotherapeutic drugs, monoclonal antibodies and complement, and CD34+ cell selection. A phase II trial in follicular non-Hodgkin's lymphoma demonstrates that patients who receive HPC products purged negative for bcl-2 gene rearrangements have a superior outcome, compared with patients who receive polymerase chain reaction (PCR)-positive products. This finding, however, has not been confirmed in a randomized trial. HPC purging has demonstrated no benefit in a phase III trial in myeloma. Phase II trials in acute myelogenous leukemia show comparable outcomes for patients who receive either purged or unpurged HPC grafts. Limitations of purging include possible progenitor cell loss, delayed engraftment, and qualitative immune defects following transplant. Data to justify routine use of HPC graft purging are insufficient. Phase I and II data support development of phase III trials of both in vivo and in vitro purging methods.
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Review |
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Shindiapina P, Pietrzak M, Seweryn M, McLaughlin E, Zhang X, Makowski M, Ahmed E, Pearson R, Kitzler R, Le-Rademacher JG, Little RF, Akpek G, Ayala E, Devine SM, Kaplan LD, Noy A, Popat UR, Hsu JW, Morris LE, Mendizabal A, Wachsman W, Williams N, Sharma N, Hofmeister CC, Forman SJ, Navarro WH, Alvarnas JC, Ambinder RF, Malvestutto C, Choe H, Behbehani G, Lozanski G, Blaser B, Baiocchi R. Update on Comparative Analysis of Immune Reconstitution in HIV-Positive Recipients of Allogeneic and Autologous Stem Cell Transplant on the BMT CTN 0903/AMC-080 and BMT CTN 0803/AMC-071 Trials. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 02/07/2023]
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Kharfan-Dabaja MA, Alvarnas JC. Recognizing Risk Factors Associated With Unplanned 30-Day Readmissions in Hematopoietic Cell Transplantation: An Opportunity to Develop Cost-Containment Strategies. JAMA Netw Open 2019; 2:e196463. [PMID: 31276171 DOI: 10.1001/jamanetworkopen.2019.6463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/14/2022] Open
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Kassab T, Loscalzo M, Clark KL, Alvarnas JC, Avanessian P, Levine AM. SupportScreen: A prospective automated approach to real-time symptom and problem identification, triage, and tailored education. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.31_suppl.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/20/2022] Open
Abstract
240 Background: The links among supportive care services quality of life, patient satisfaction, cost, quality and safety are well established. The Institute of Medicine 2008 report recommended that distress screening be instituted as the standard of cancer care. More recently, ASCO and ACOS created new standards for the universal distress screening. Parallel to this process have been advances in automated technologies that are efficient and easily tailored to the patient population. Methods: SupportScreen is a patient-friendly automated process that identifies, triages and provides educational information all in real time. SupportScreen also facilitates patient, physician and multi-specialist communication and is used to maximize the effectiveness of clinical encounters and overall cancer care. Results: Based on over 15 years of biopsychosocial screening experience, SupportScreen was implemented at the City of Hope as a standard of care in medical oncology, HEM/HCT and surgery outpatient clinics. SupportScreen is also being administered to caregivers and to collect patient satisfaction and research data. In a sample of 4,819 outpatients the top problems rated as high distress are: problems with finances (40%), sleep (38.3%), worry about the future (37.1%), fatigue (36.7%) and side effects of treatments (34.5%). In addition, patients requested assistance (meet with a member of team or educational materials) in many areas related to their quality and coordination of medical care: finances (33.6%), health insurance (27.5%), finding community resources (26.6%), talking with the health care team (26.3%), needing help coordinating my medical care (24%) and transportation (20.7%). Conclusions: Patients and their caregivers have a significant number of unmet needs that may directly impact the quality, safety, and cost of their care. Prospectively managing these barriers may enhance the quality and efficiency of care, especially in those patients who manifest high risk, cost and suffering characteristics.
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Alvarnas JC, Kassab T, Avanessian P, Pierce M, Levine AM. The City of Hope (COH) performance excellence program (PEP): A physician incentive program to improve health care performance (HCP) in an academic medical center. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e17556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/20/2022] Open
Abstract
e17556 Background: The Affordable Care Act (ACA) introduced a pay for performance model focused on: safety, timeliness, effectiveness, efficiency, patient-centered, equitable care. COH is an NCI sponsored Comprehensive Cancer Center, focused on cancer care. Methods: In 2011, a physician led team with representation from finance, QRRM, nursing and legal identified 13 quality measures (QM) where opportunities for improvement (OFI) existed. Selection criteria included measurability, importance, applicability to ACA, physician impact, return on investment and national importance. The QM include HCAHPS score, Healthcare Associated Infection rate (HAI), quantity of blood products internally produced (BP), coder response rate (RR), use of sepsis bundle orders, time to new patient appointments (NPA), OR 1st case on-time starts, timeliness of adjuvant therapy for breast/colon cancer patients, SCIP composite score and use of VTE prophylaxis orders. HCP for the first 4 QM was assessed based upon institutional performance; 6 QM were assessed upon departmental performance. There were 3 build measures (BM): creating a system to obtain advanced directives (AD) on all new patients, creating a system for effective communication with referring physicians and 4 departmental BM based on best practices. Results: PEP performance was assessed between 5/1/12-12/31/12. 174 physicians in 11 departments were eligible for a $2.05 million incentive pool. QM were evaluated using a tiered bonus structure. Significant improvements were seen in HAI, BP production, SCIP, OR starts and timely adjuvant therapy. There were improvements in the use of VTE orders, but aggregate performance fell below payment threshold. The build measure for AD was completed. Conclusions: (1) PEP is an effective tool for physician engagement in an academic medical center. (2) PEP enhanced alignment between the medical group, hospital, nursing and administration. (3) PEP was effective in improving HCP in less than one year from its inception. [Table: see text]
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