1
|
Mazimba C, Salafian K, Volodin L, Pilehvari A, You W, Ballen KK. The Impact of Social Vulnerability Index on Survival Following ASCT for Multiple Myeloma. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
2
|
Lucchesi NP, Young P, Mathone R, Volodin L, Ballen KK, Varadarajan I. Impact of Crystalloid Administration on Patients Receiving Haploidentical Allogeneic Stem Cell Transplant (Haplo SCT) with Post Transplant Cytoxan Prophylaxis (PtCy): a Quality Improvement Initiative. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
3
|
El Chaer F, Ballen KK. Measurable residual disease for secondary acute myeloid leukemia prior to allogeneic hematopoietic cell transplantation: does it make a difference? Bone Marrow Transplant 2022; 57:1473-1474. [PMID: 35902643 DOI: 10.1038/s41409-022-01765-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Firas El Chaer
- Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen K Ballen
- Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA.
| |
Collapse
|
4
|
Varadarajan I, Horton B, Volodin L, Kindwall-Keller T, Ballen KK. Effects of Prebiotics on GUT Microbiome in Patients Undergoing STEM Cell Transplants- Updates on Phase I Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
5
|
Varadarajan I, Singh S, Vassalos I, Volodin L, Kindwall-Keller T, Ballen KK. Impact of Cytokine Release Syndrome (CRS) in Haplo-Identical Stem Cell Transplantation (Haplo). Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
6
|
Metheny L, Politikos I, Ballen KK, Rezvani AR, Milano F, Barker JN, Brunstein CG. Guidelines for Adult Patient Selection and Conditioning Regimens in Cord Blood Transplant Recipients with Hematologic Malignancies and Aplastic Anemia. Transplant Cell Ther 2021; 27:286-291. [PMID: 33836867 DOI: 10.1016/j.jtct.2020.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
For cord blood transplantation (CBT), appropriate patient and conditioning regimen selection is necessary to achieve long-term disease-free survival. This review aims to provide comprehensive guidelines on these issues using evidence from the literature and experience at dedicated CBT centers. Topics include patient and disease characteristics that make CBT a good or poor choice and a review of outcomes in commonly used conditioning regimens in CBT. This is accompanied with recommendations on regimen intensity based on disease, organ function, and patient performance status and age. In addition, the use of antithymocyte globulin in CBT is discussed, as is the choice of conditioning in aplastic anemia patients who have access to acceptable CB units.
Collapse
Affiliation(s)
- Leland Metheny
- Stem Cell Transplant Program, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen K Ballen
- University of Virginia Cancer Center, Charlottesville, Virginia
| | - Andrew R Rezvani
- Division of Blood & Marrow Transplantation, Stanford University, Stanford, California
| | - Filippo Milano
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Claudio G Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | | |
Collapse
|
7
|
Reed DR, Petroni GR, West M, Jones C, Alfaraj A, Williams PG, DeGregory K, Grose K, Monson S, Varadarajan I, Volodin L, Donowitz GR, Kindwall-Keller TL, Ballen KK. Prophylactic pretransplant ganciclovir to reduce cytomegalovirus infection after hematopoietic stem cell transplantation. Hematol Oncol Stem Cell Ther 2021; 16:61-69. [PMID: 36634280 DOI: 10.1016/j.hemonc.2021.05.001] [Citation(s) in RCA: 1] [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] [Received: 08/26/2020] [Revised: 03/22/2021] [Accepted: 05/24/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE/BACKGROUND Cytomegalovirus (CMV) reactivation remains a serious complication after allogeneic hematopoietic cell transplantation (HCT) occurring in approximately 60-70% of CMV-seropositive HCT recipients. CMV reactivation leads to adverse outcomes including end-organ damage, graft-versus-host disease, and graft failure. METHODS Ganciclovir was administered pretransplant at 5 mg/kg twice daily intravenously from the start of conditioning to Day T-2 to CMV-seropositive patients receiving their first allogeneic HCT. CMV DNA was monitored weekly until at least Day 100 posttransplant. RESULTS A total of 109 consecutive patients were treated, median age 57 (range 20-73) years. Of these, 36 (33%) patients had a CMV reactivation within the first 105 days posttransplant with a median time of reactivation of 52.5 (range 36-104) days posttransplant. The cumulative incidence of CMV reactivation at Day 105 posttransplant was 33.1% (95% confidence interval: 24.4-42.0). One patient developed CMV disease. CONCLUSION The use of pretransplant ganciclovir was associated with low incidence of CMV reactivation and disease. These data suggest that pretransplant ganciclovir with preemptive therapy for viral reactivation may be a useful strategy to reduce CMV reactivation. Future prospective trials are needed to compare strategies for CMV prophylaxis.
Collapse
Affiliation(s)
- Daniel R Reed
- Section of Hematology and Oncology, Comprehensive Cancer Center of Wake Forest Baptist Health, Winston-Salem, NC, USA.
| | - Gina R Petroni
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Melissa West
- Department of Pharmacy, University of Virginia, Charlottesville, VA, USA
| | - Caroline Jones
- Department of Pharmacy, University of Virginia, Charlottesville, VA, USA
| | - Abeer Alfaraj
- BayHealth Hematology/Oncology Associates, Delaware, PA, USA
| | - Paige G Williams
- Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Kathlene DeGregory
- Department of Pharmacy, University of Virginia, Charlottesville, VA, USA
| | - Kyle Grose
- Department of Pharmacy, University of Kansas, Kansas City, KS, USA
| | - Sandra Monson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Indumathy Varadarajan
- Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Leonid Volodin
- Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Gerald R Donowitz
- Department of Infectious Disease, University of Virginia, Charlottesville, VA, USA
| | | | - Karen K Ballen
- Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
8
|
Isaac KM, Reed DR, Desai RP, Williams E, Balkrishnan R, Keng MK, Ballen KK. Epidemiology of acute myeloid leukemia in Virginia: Excellent survival outcomes for patients in rural Appalachia. Cancer Rep (Hoboken) 2021; 4:e1354. [PMID: 33751859 PMCID: PMC8388176 DOI: 10.1002/cnr2.1354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/20/2021] [Accepted: 02/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background Acute myeloid leukemia, the most common acute leukemia in adults, has a poor overall survival. Studies have suggested that certain socioeconomic factors such as living in a rural or farming area are associated with worse outcomes. Since 42% of acute myeloid leukemia patients seen in our academic center reside in a rural area, we have a unique opportunity to study outcomes of patients in rural versus urban settings. Aim This analysis evaluates the effect of geography and socioeconomic factors on the biology, treatment, and overall survival of patients with acute myeloid leukemia, with the goal of understanding health care disparities. Methods and results Patient characteristics, cytogenetic data, treatment history, and overall survival were collected and analyzed to identify differences between urban and rural residency. This cohort included 42% of patients who resided in a rural area at the time of acute myeloid leukemia diagnosis. There was no difference in overall survival between the cohorts. The 1 year overall survival for the entire cohort was 47.9%. There was no difference detected in rates of adverse cytogenetics between the rural and urban cohorts. Similar numbers of patients received induction chemotherapy or proceeded to allogeneic stem cell transplant between the cohorts. Conclusions This study highlights that similar outcomes can be achieved in rural and urban patients, suggesting that intensive efforts at telehealth, education, and collaboration with local oncology practices may be beneficial.
Collapse
Affiliation(s)
- Krista M Isaac
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Daniel R Reed
- Section on Hematology/Oncology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Raj Piyush Desai
- Cancer Population Health Core, University of Virginia Cancer Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Eli Williams
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rajesh Balkrishnan
- Cancer Population Health Core, University of Virginia Cancer Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Michael K Keng
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Karen K Ballen
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia, USA
| |
Collapse
|
9
|
Wang JS, Elghawy O, Hafey AC, Renaghan A, Bushnaq-Aloul H, Mazimba C, Ballen KK, Kindwall-Keller TL. Minimal Change Disease (MCD) Secondary to Chronic Graft Versus Host Disease (GVHD) in Two Adult Patients after Allogeneic (Allo) Hematopoietic Cell Transplant (HCT) for Myelodysplastic Syndrome (MDS). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
10
|
Mock J, Nguyen C, Arora P, Heron C, Mau LW, Meyer C, Balkrishnan R, Devine SM, Ballen KK. Geographic and Socioeconomic Disparities in Hematopoietic Cell Transplantation Among Acute Myeloid Leukemia Patients in Virginia. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
11
|
Elghawy O, Wang JS, Hafey AC, Kassay-McAllister J, Bushnaq-Aloul H, Mazimba C, Williams P, Varadarajan I, Volodin L, Ballen KK, Kindwall-Keller TL. Allogeneic Hematopoietic Cell Transplant (HCT) Complications Requiring Transfer to the Intensive Care Unit (ICU) in a Medium Size Program. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00479-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
12
|
Abstract
PURPOSE OF REVIEW Rearrangements of the histone lysine [K]-MethylTransferase 2A gene (KMT2A) gene on chromosome 11q23, formerly known as the mixed-lineage leukemia (MLL) gene, are found in 10% and 5% of adult and children ALL cases, respectively. The most common translocated genes are AFF1 (formerly AF4), MLLT3 (formerly AF9), and MLLT1 (formerly ENL). The bimodal incidence of MLL-r-ALL usually peaks in infants in their first 2 years of life and then declines thereafter during the pediatric/young adult phase until it increases again with age. MLL-rearranged ALL (MLL-r-ALL) is characterized by hyperleukocytosis, aggressive behavior with early relapse, relatively high incidence of central nervous system (CNS) involvement, and poor prognosis. RECENT FINDINGS MLL-r-ALL cells are characterized by relative resistance to corticosteroids (due to Src kinase-induced phosphorylation of annexin A2) and L-asparaginase therapy, but they are sensitive to cytarabine chemotherapy (due to increased levels of hENT1 expression). Potential therapeutic targets include FLT3 inhibitors, MEK inhibitors, HDAC inhibitors, BCL-2 inhibitors, MCL-1 inhibitors, proteasome inhibitors, hypomethylating agents, Dot1L inhibitors, and CDK inhibitors. In this review, we discuss MLL-r-ALL focusing on clinical presentation, risk stratification, drug resistance, and treatment strategies, including potential novel therapeutic targets.
Collapse
Affiliation(s)
- Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, 1215 Lee Street, Charlottesville, VA, 22903, USA
| | - Michael Keng
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, 1215 Lee Street, Charlottesville, VA, 22903, USA
| | - Karen K Ballen
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, 1215 Lee Street, Charlottesville, VA, 22903, USA.
| |
Collapse
|
13
|
El Fakih R, Greinix H, Koh M, Shaw B, Mohty M, Al Nahedh M, Saber W, Kharfan-Dabaja MA, Perales MA, Savani BN, Majhail NS, Passweg JR, Sureda A, Ahmed SO, Gluckman E, Riches M, El-Jawahri A, Rondelli D, Srivastava A, Faulkner L, Atsuta Y, Ballen KK, Rasheed W, Okamoto S, Seber A, Chao N, Kröger N, Kodera Y, Szer J, Hashmi SK, Horowitz MM, Weisdorf D, Niederwieser D, Aljurf M. Worldwide Network for Blood and Marrow Transplantation (WBMT) Recommendations Regarding Essential Medications Required To Establish An Early Stage Hematopoietic Cell Transplantation Program. Transplant Cell Ther 2020; 27:267.e1-267.e5. [PMID: 33781535 DOI: 10.1016/j.jtct.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/19/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Establishing a hematopoietic cell transplantation (HCT) program is complex. Planning is essential while establishing such a program to overcome the expected challenges. Authorities involved in HCT program establishment will need to coordinate the efforts between the different departments required to start up the program. One essential department is pharmacy and the medications required. To help facilitate this, the Worldwide Network for Blood and Marrow Transplantation organized a structured survey to address the essential medications required to start up an HCT program. A group of senior physicians and pharmacists prepared a list of the medications used at the different phases of transplantation. These drugs were then rated by a questionnaire using a scale of necessity based on the stage of development of the transplant program. The questionnaire was sent to 30 physicians, in different parts of the world, who have between 5 and 40 years of experience in autologous and/or allogeneic transplantation. This group of experts scored each medication on a 7-point scale, ranging from an absolute requirement (score of 1) to not required (score of 7). The results are presented here to help guide the prioritization of required medications.
Collapse
Affiliation(s)
- Riad El Fakih
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | | | - Mickey Koh
- St. George's Hospital and Medical School, London, United Kingdom; Cell Therapy Facility, Blood Services Group, Health Sciences Authority, Singapore
| | - Bronwen Shaw
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohamad Mohty
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Mohammad Al Nahedh
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Wael Saber
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Jakob R Passweg
- Hematology Division, Basel University Hospital, Basel, Switzerland
| | - Anna Sureda
- Catalan Institute of Oncology, Barcelona, Spain
| | - Syed Osman Ahmed
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Marcie Riches
- Division of Hematology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Areej El-Jawahri
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Damiano Rondelli
- University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Yoshiko Atsuta
- Center for Hematopoietic Stem Cell Transplantation, Aichi Medical University Hospital, Nagakute, Japan
| | - Karen K Ballen
- Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Walid Rasheed
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shinichiro Okamoto
- Department of Medicine, Division of Hematology, Keio University School of Medicine, Tokyo, Japan
| | - Adriana Seber
- Universidade Federal de Sao Paulo Escola Paulista de Medicina, São Paulo, Brazil
| | - Nelson Chao
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jeff Szer
- Clinical Haematology at Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Shahrukh K Hashmi
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mary M Horowitz
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Dietger Niederwieser
- Division of Haematology and Medical Oncology, University of Leipzig, Leipzig, Germany
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
14
|
Kindwall-Keller TL, Ballen KK. Umbilical cord blood: The promise and the uncertainty. Stem Cells Transl Med 2020; 9:1153-1162. [PMID: 32619330 PMCID: PMC7519764 DOI: 10.1002/sctm.19-0288] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 09/05/2019] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022] Open
Abstract
Unfortunately, many patients referred for hematopoietic cell transplant will not have a fully matched related donor, and finding matched unrelated donors through the registry may be difficult, especially if the recipient is not of Northern European descent [N Engl J Med 2014;371:339‐348]. Umbilical cord blood (UCB) has been an available graft source for hematopoietic cell transplant for more than 30 years, since the first UCB transplant was performed in the late 1980s [N Engl J Med 1989;321:1174‐1178]. UCB is readily available, has low immunogenicity, and does not require as strict of human leukocyte antigen (HLA) matching compared to other graft sources [N Engl J Med 2004;351:2265‐2275]. According to data from the Center for International Blood and Marrow Transplant Research (CIBMTR), an estimated 500 patients in the US will have received a UCB transplant in 2018. Since 2014, haploidentical transplants have surpassed UCB transplants performed in the United States (CIBMTR Summary Slides, 2018, available at https://www.cibmtr.org). Increased use of haploidentical transplants has brought to light concerns about UCB transplants, including delayed engraftment and graft failure, increased nonrelapse mortality, increased infection risk, and UCB acquisition costs [Lancet Oncol 2010;11:653‐660; Biol Blood Marrow Transplant 2019;1456‐1464]. These concerns will need to be addressed for UCB to remain a viable option as a graft source for hematopoietic cell transplant. Other promising therapeutic benefits for UCB, in addition to hematopoietic cell transplant, is its use in regenerative medicine and immune modulation, which is currently being evaluated in ongoing clinical trials.
Collapse
Affiliation(s)
| | - Karen K Ballen
- Division of Hematology/Oncology, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
15
|
Volodin L, Ballen KK. Allogeneic Transplantation for Myelofibrosis with Novel Graft-versus-Host Disease Prophylaxis. Acta Haematol 2020; 144:124-125. [PMID: 32570245 DOI: 10.1159/000508198] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Leonid Volodin
- Division of Hematology/Oncology, University of Virginia Cancer Center, Charlottesville, Virginia, USA,
| | - Karen K Ballen
- Division of Hematology/Oncology, University of Virginia Cancer Center, Charlottesville, Virginia, USA
| |
Collapse
|
16
|
Wagner JE, Ballen KK, Zhang MJ, Johnson MH, Karanas C, Milano F, Verneris MR, Eapen M. Comparison of Haploidentical Related Donor with Post-Transplant Cyclophosphamide (PTCy) and Umbilical Cord Blood (UCB) Transplantation after Myeloablative Conditioning for Hematological Malignancy. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
17
|
Brunner AM, Blonquist TM, DeAngelo DJ, McMasters M, Fell G, Hermance NM, Winer ES, Lindsley RC, Hobbs GS, Amrein PC, Hock HR, Steensma DP, Garcia JS, Luskin MR, Stone RM, Ballen KK, Rosenblatt J, Avigan D, Nahas MR, Mendez LM, McAfee SL, Moran JA, Bergeron M, Foster J, Bertoli C, Manning AL, McGregor KL, Fishman KM, Kuo FC, Baltay MT, Macrae M, Burke M, Behnan T, Wey MC, Som TT, Ramos AY, Rae J, Lombardi Story J, Nelson N, Logan E, Connolly C, Neuberg DS, Chen YB, Graubert TA, Fathi AT. Alisertib plus induction chemotherapy in previously untreated patients with high-risk, acute myeloid leukaemia: a single-arm, phase 2 trial. Lancet Haematol 2020; 7:e122-e133. [PMID: 31837959 PMCID: PMC10354959 DOI: 10.1016/s2352-3026(19)30203-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Increased aurora A kinase (AAK) expression occurs in acute myeloid leukaemia; AAK inhibition is a promising therapeutic target in this disease. We therefore aimed to assess the activity of alisertib combined with 7 + 3 induction chemotherapy in previously untreated patients with high-risk acute myeloid leukaemia. METHODS We did a single-arm, phase 2 trial of patients recruited from the Dana-Farber/Harvard Cancer Center in the USA. Eligible patients had previously untreated acute myeloid leukaemia, an Eastern Cooperative Oncology Group performance status of 0-2, and were at high risk of disease as defined by the presence of an adverse-risk karyotype, the presence of secondary acute myeloid leukaemia arising from previous myelodysplastic syndrome or myeloproliferative neoplasm, the presence of therapy-related acute myeloid leukaemia, or being 65 years or older. Enrolled patients received 7 + 3 induction chemotherapy of continuous infusion of cytarabine (100 mg/m2 per day on days 1-7) and intravenous bolus of idarubicin (12 mg/m2 per day on days 1-3). Oral alisertib (30 mg) was given twice per day on days 8-15. Patients could receive up to four consolidation cycles with cytarabine and alisertib, and alisertib maintenance for 12 months. The primary endpoint was a composite including the proportion of patients achieving complete remission and those with a complete remission with incomplete neutrophil or platelet count recovery. Analyses were per-protocol. This study is registered with Clinicaltrials.gov, number NCT02560025, and has completed enrolment. FINDINGS Between Dec 31, 2015, and Aug 1, 2017, we enrolled a total of 39 eligible patients. 19 (49%) of 39 patients had secondary acute myeloid leukaemia and three (8%) had therapy-related acute myeloid leukaemia. At mid-induction, 33 (85%) of 39 patients showed marrow aplasia, six (15%) received re-induction. The median follow-up was 13·7 months (IQR 12·7-14·4). Composite remission was 64% (two-stage 95% CI 48-79), with 20 (51%) of 39 patients achieving complete remission and five (13%) achieving complete remission with incomplete neutrophil or platelet count recovery. The most common grade 3 or 4 adverse events included febrile neutropenia (16 [41%] of 39), neutropenia (12 [31%]), thrombocytopenia (13 [33%]), anaemia (11 [28%]), anorexia (nine [23%]), and oral mucositis (four [10%]). No treatment-related deaths were observed. INTERPRETATION These results suggest that alisertib combined with induction chemotherapy is active and safe in previously untreated patients with high-risk acute myeloid leukaemia. This study met criteria to move forward to a future randomised trial. FUNDING Millennium Pharmaceuticals.
Collapse
Affiliation(s)
- Andrew M Brunner
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Traci M Blonquist
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Daniel J DeAngelo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Geoffrey Fell
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nicole M Hermance
- Department of Biology, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Eric S Winer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Gabriela S Hobbs
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Philip C Amrein
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Hanno R Hock
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - David P Steensma
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Marlise R Luskin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Richard M Stone
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Karen K Ballen
- Division of Hematology-Oncology, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Jacalyn Rosenblatt
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Avigan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Myrna R Nahas
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lourdes M Mendez
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Steven L McAfee
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Jenna A Moran
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Meghan Bergeron
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Julia Foster
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Christina Bertoli
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Amity L Manning
- Department of Biology, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Kristin L McGregor
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Kaitlyn M Fishman
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Frank C Kuo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Michele T Baltay
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Molly Macrae
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Meghan Burke
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Tanya Behnan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Margaret C Wey
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Tina T Som
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Aura Y Ramos
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Jessica Rae
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | - Nicole Nelson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Emma Logan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christine Connolly
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Donna S Neuberg
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Yi-Bin Chen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Timothy A Graubert
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Amir T Fathi
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
18
|
Narayan R, Blonquist TM, Emadi A, Hasserjian RP, Burke M, Lescinskas C, Neuberg DS, Brunner AM, Hobbs G, Hock H, McAfee SL, Chen Y, Attar E, Graubert TA, Bertoli C, Moran JA, Bergeron MK, Foster JE, Ramos AY, Som TT, Vartanian MK, Story JL, McGregor K, Macrae M, Behnan T, Wey MC, Rae J, Preffer FI, Lesho P, Duong VH, Mann ML, Ballen KK, Connolly C, Amrein PC, Fathi AT. A phase 1 study of the antibody‐drug conjugate brentuximab vedotin with re‐induction chemotherapy in patients with CD30‐expressing relapsed/refractory acute myeloid leukemia. Cancer 2019; 126:1264-1273. [DOI: 10.1002/cncr.32657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/13/2019] [Accepted: 11/04/2019] [Indexed: 01/21/2023]
|
19
|
Abstract
Aggressive curative therapies have now been extended to patients older than 65 years, a fast-growing segment of the population. As the number of allogeneic transplants in patients older than age 65 is increasing, attention is now focused on improving outcomes in this group. This paper discusses important aspects of allogeneic transplant in the older patient, focusing on donor and patient selection, choice of conditioning regimen and graft source, and the importance of timely access to a transplant center.
Collapse
Affiliation(s)
- Indumathy Varadarajan
- University of Virginia Cancer Center, 1300 Jefferson Park Avenue, Charlottesville, VA, 22908, USA
| | - Karen K Ballen
- University of Virginia Cancer Center, 1300 Jefferson Park Avenue, Charlottesville, VA, 22908, USA.
| |
Collapse
|
20
|
El Chaer F, Ballen KK. Treatment of acute leukaemia in adult Jehovah's Witnesses. Br J Haematol 2019; 190:696-707. [PMID: 31693175 DOI: 10.1111/bjh.16284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/18/2019] [Indexed: 01/28/2023]
Abstract
Since Jehovah's Witness (JW) patients diagnosed with leukaemia refuse blood transfusions, they are often denied intensive chemotherapy for fear they could not survive myeloablation without blood transfusion support. Treatment of JW patients with acute leukaemia is challenging and carries a higher morbidity and mortality; however, the refusal of blood products should not be an absolute contraindication to offer multiple treatment modalities including haematopoietic stem cell transplantation. In this review we discuss their optimal management and describe alternative modalities to blood transfusions to provide sufficient oxygenation and prevent bleeding.
Collapse
Affiliation(s)
- Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen K Ballen
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| |
Collapse
|
21
|
Karantanos T, Kim HT, Tijaro-Ovalle NM, Li L, Cutler C, Antin JH, Ballen KK, Ritz J, Politikos I, Boussiotis VA. Assessment of a multi-cytokine profile by a novel biochip-based assay allows correlation of cytokine profiles with clinical outcomes in adult recipients of umbilical cord blood transplantation. Bone Marrow Transplant 2019; 55:1821-1823. [PMID: 31578466 PMCID: PMC7113100 DOI: 10.1038/s41409-019-0707-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/06/2019] [Accepted: 07/28/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Theodoros Karantanos
- Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Medical Oncology, Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - Natalia M Tijaro-Ovalle
- Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lequn Li
- Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Karen K Ballen
- University of Virginia Health Center, Charlottesville, VA, USA
| | - Jerome Ritz
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vassiliki A Boussiotis
- Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
22
|
Muhsen IN, Hashmi SK, Niederwieser D, Kroeger N, Agrawal S, Pasquini MC, Atsuta Y, Ballen KK, Seber A, Saber W, Kharfan-Dabaja MA, Rasheed W, Okamoto S, Khera N, Wood WA, Koh MBC, Greinix H, Kodera Y, Szer J, Horowitz MM, Weisdorf D, Aljurf M. Worldwide Network for Blood and Marrow Transplantation (WBMT) perspective: the role of biosimilars in hematopoietic cell transplant: current opportunities and challenges in low- and lower-middle income countries. Bone Marrow Transplant 2019; 55:698-707. [PMID: 31484992 DOI: 10.1038/s41409-019-0658-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/28/2019] [Accepted: 07/05/2019] [Indexed: 12/18/2022]
Abstract
Health care costs attributed to biologics have increased exponentially in the recent years, thus biosimilars offer a possible solution to limit costs while maintaining safety and efficacy. Reducing expenditure is vital to health care especially in developing countries where affordability and access to health care is a major challenge. We discuss the opportunities and the challenges of biosimilars in the field of hematopoietic cell transplantation (HCT) in low- and lower-middle income countries. Developing countries can potentially invest in the forecasted costs reduction by utilizing biosimilars. This can be used to decrease the costs of procedures such as HCT, which is a rapidly growing field in many developing regions. The introduction of biosimilars in the developing regions faces many challenges which include, but are not limited to: legal and regulatory issues, lack of research infrastructure, and the presence of educational barriers. Thus, collaborative efforts are needed to ensure an effective and safe introduction of biosimilars into low- and lower-middle income countries.
Collapse
Affiliation(s)
- Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Shahrukh K Hashmi
- Hematology Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. .,Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Dietger Niederwieser
- Department of Hematology and Medical Oncology, University of Leipzig, Leipzig, Germany
| | - Nicolaus Kroeger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Samir Agrawal
- Division of Haemato-Oncology, Bart's Health NHS Trust and Blizard Institute, Queen Mary University of London, London, UK
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
| | - Karen K Ballen
- Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Wael Saber
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | - Mohamed A Kharfan-Dabaja
- Department of Medicine, Division of Hematology-Oncology and Blood and Marrow Transplantation program, Mayo Clinic, Jacksonville, FL, USA
| | - Walid Rasheed
- Hematology Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Nandita Khera
- Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Yoshihisa Kodera
- Center for Hematopoietic Stem Cell Transplantation, Aichi Medical University Hospital, Nagakute, Japan
| | - Jeff Szer
- Department of Clinical Haematology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | | | - Mahmoud Aljurf
- Hematology Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| |
Collapse
|
23
|
Dowling MR, Ballen KK. Neurological Complications after Allogeneic Transplantation - Can We Do Better? Acta Haematol 2019; 142:193-194. [PMID: 31315109 DOI: 10.1159/000501297] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Mark R Dowling
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia,
| | - Karen K Ballen
- University of Virginia Cancer Center, Charlottesville, Virginia, USA
| |
Collapse
|
24
|
Lum LG, Le TM, Choi M, Thakur A, Reilley M, Kunk PR, Deol A, Ballen KK, Kindwall-Keller TL, Schalk D, Kubicka E, Huang M, Philip PA, Aoun H, Dyson G, Liu Q, Shields AF. Clinical and immune responses using anti-CD3 x anti-EGFR bispecific antibody armed T cells (BATs) for locally advanced or metastatic pancreatic cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
4135 Background: Conventional chemotherapy (chemo) for locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC) has dismal responses and poor survival rates. Arming activated T cells (ATC) with anti-CD3 x anti-EGFR bispecific antibody (BATs) makes every ATC into an EGFR-specific cytotoxic T cell that secretes cytokines, proliferates, and kills tumor. Methods: We report on 5 phase I (P1) and 15 phase II (P2) patients. In our phase I study, BATs were used to treat LAPC or MPC patients at Karmanos Cancer Institute (NCT0140874) in a dose escalation involving 3 weekly infusions of 1, 2, and 4 x 1010 BATs/infusion, followed by a booster infusion at 3 months (mos) for a total of up to 8 x 1010 BATs. No dose limiting toxicities were observed in the outpatient infusions. Fifteen patients treated on a phase II (NCT02620865) at KCI and (NCT03269526) at University of Virginia received biweekly infusions of 1010 BATs/infusion over 4 weeks for a total of 8 x 1010 EGFR BATs. Results: Four patients had stable disease (SD) for 6.1, 6.5, 5.3, and 36 mos. Two patients had complete responses (CR) when chemo was restarted after BATs. The median overall survival (OS) for 17 evaluable patients (3 of 4 infusions in the P1 and all 8 infusions in the P2) was 31 mos, and the median OS for all 20 patients (3 in the P2 who did not complete 8 infusions) is 14.5 mos (95% CI, 7.5-45.2 mos). Patient IT20104 had an apparent “pseudoprogression” after 3 BATs infusions, but achieved a CR after restarting capcitabine and is alive off therapy at 54 mos (24 mos after stopping capecitabine). Immune evaluations on the P1 patients show specific cytotoxicity to MiaPaCa-2 by peripheral blood mononuclear cells (PBMC) increased from 21% to 31% 2 weeks after the 3rd infusion, and IFN-γ EliSpots increased from < 20 to 1000 IFN-γ EliSpots/106 PBMC (p < 0.03). Patient IT 20121 (SD for 36 mos) increased IFN-γ EliSpots from 250 to 3200/106 PBMC after 8 infusions. Innate cytotoxicity responses in the P1 patients increased significantly after infusions (p < 0.04). Levels of IP-10 increased significantly (p < 0.04), and levels of IL-8 decreased but not significantly (p < 0.07). Conclusions: Infusions of BATs are safe and induce endogenous adaptive anti-tumor responses. Targeting PC with BATs may stabilize disease, leading to improved OS, as well as evidence that BATs infusions can induce anti-tumor activity and immunosensitize tumors to subsequent chemo. Clinical trial information: NCT014084,NCT03269526,NCT02620865.
Collapse
Affiliation(s)
| | | | | | | | - Matthew Reilley
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Abhinav Deol
- Blood and Marrow Transplant Program, Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | | | | | | | | | | | | | - Hussein Aoun
- Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI
| | - Gregory Dyson
- Department of Statistics, Wayne State University, Detroit, MI
| | - Qin Liu
- Wistar Institute, Philadelphia, PA
| | | |
Collapse
|
25
|
Reed DR, Alfaraj A, Petroni G, Monson S, Williams P, DeGregory K, Volodin L, Kindwall-Keller TL, Ballen KK. Prophylactic Pretransplant Ganciclovir to Reduce Cytomegalovirus Infection after Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.586] [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]
|
26
|
Arora P, Duarte L, Mau LW, Meyer C, Senneka M, Murphy EA, Desai R, Balkrishnan R, Burns LJ, Ballen KK. Access to Allogeneic Hematopoietic Cell Transplantation (HCT) for Patients with Acute Myeloid Leukemia (AML) in the State of Virginia. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
Brunner AM, Neuberg DS, Wander SA, Sadrzadeh H, Ballen KK, Amrein PC, Attar E, Hobbs GS, Chen YB, Perry A, Connolly C, Joseph C, Burke M, Ramos A, Galinsky I, Yen K, Yang H, Straley K, Agresta S, Adamia S, Borger DR, Iafrate A, Graubert TA, Stone RM, Fathi AT. Isocitrate dehydrogenase 1 and 2 mutations, 2-hydroxyglutarate levels, and response to standard chemotherapy for patients with newly diagnosed acute myeloid leukemia. Cancer 2019; 125:541-549. [PMID: 30422308 DOI: 10.1002/cncr.31729] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) cells harboring mutations in isocitrate dehydrogenase 1 (IDH1) and isocitrate dehydrogenase 2 (IDH2) produce the oncometabolite 2-hydroxyglutarate (2HG). This study prospectively evaluated the 2HG levels, IDH1/2 mutational status, and outcomes of patients receiving standard chemotherapy for newly diagnosed AML. METHODS Serial samples of serum, urine, and bone marrow aspirates were collected from patients newly diagnosed with AML, and 2HG levels were measured with mass spectrometry. Patients with baseline serum 2HG levels greater than 1000 ng/mL or marrow pellet 2HG levels greater than 1000 ng/2 × 106 cells, which suggested the presence of an IDH1/2 mutation, underwent serial testing. IDH1/2 mutations and estimated variant allele frequencies were identified. AML characteristics were compared with the Wilcoxon test and Fisher's exact test. Disease-free survival and overall survival (OS) were evaluated with log-rank tests and Cox regression. RESULTS Two hundred and two patients were treated for AML; 51 harbored IDH1/2 mutations. IDH1/2-mutated patients had significantly higher 2HG levels in serum, urine, bone marrow aspirates, and aspirate cell pellets than wild-type patients. A serum 2HG level greater than 534.5 ng/mL was 98.8% specific for the presence of an IDH1/2 mutation. Patients with IDH1/2-mutated AML treated with 7+3-based induction had a 2-year event-free survival (EFS) rate of 44% and a 2-year OS rate of 57%. There was no difference in complete remission rates, EFS, or OS between IDH1/2-mutated and wild-type patients. Decreased serum 2HG levels on day 14 as a proportion of the baseline were significantly associated with improvements in EFS (P = .047) and OS (P = .019) in a multivariate analysis. CONCLUSIONS Among patients with IDH1/2-mutated AML, 2HG levels are highly specific for the mutational status at diagnosis, and they have prognostic relevance in patients receiving standard chemotherapy.
Collapse
Affiliation(s)
| | | | - Seth A Wander
- Massachusetts General Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | - Eyal Attar
- Massachusetts General Hospital, Boston, Massachusetts.,Agios Pharmaceuticals, Cambridge, Massachusetts
| | | | - Yi-Bin Chen
- Massachusetts General Hospital, Boston, Massachusetts
| | - Ashley Perry
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Meghan Burke
- Massachusetts General Hospital, Boston, Massachusetts
| | - Aura Ramos
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Hua Yang
- Agios Pharmaceuticals, Cambridge, Massachusetts
| | | | - Sam Agresta
- Agios Pharmaceuticals, Cambridge, Massachusetts
| | | | | | | | | | | | - Amir T Fathi
- Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
28
|
Lum LG, Choi M, Le TM, Thakur A, Deol A, Ballen KK, Volodin L, Kindwall-Keller TL, Liu Q, Dyson G, Shields AF. Targeting advanced pancreatic cancer with activated t cells armed with anti-CD3 x anti-EGFR bispecific antibody. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Archana Thakur
- University of Virginia Cancer Center, Charlottesville, VA
| | - Abhinav Deol
- Blood and Marrow Transplant Program, Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | | | - Leonid Volodin
- University of Virginia school of medicine, Charlottesville, VA
| | | | - Qin Liu
- Wistar Institute, Philadelphia, PA
| | - Gregory Dyson
- Department of Statistics, Wayne State University, Detroit, MI
| | | |
Collapse
|
29
|
DeFilipp Z, Peled JU, Li S, Mahabamunuge J, Dagher Z, Slingerland AE, Del Rio C, Valles B, Kempner ME, Smith M, Brown J, Dey BR, El-Jawahri A, McAfee SL, Spitzer TR, Ballen KK, Sung AD, Dalton TE, Messina JA, Dettmer K, Liebisch G, Oefner P, Taur Y, Pamer EG, Holler E, Mansour MK, van den Brink MRM, Hohmann E, Jenq RR, Chen YB. Third-party fecal microbiota transplantation following allo-HCT reconstitutes microbiome diversity. Blood Adv 2018; 2:745-753. [PMID: 29592876 PMCID: PMC5894265 DOI: 10.1182/bloodadvances.2018017731] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [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: 02/20/2018] [Accepted: 02/27/2018] [Indexed: 12/16/2022] Open
Abstract
We hypothesized that third-party fecal microbiota transplantation (FMT) may restore intestinal microbiome diversity after allogeneic hematopoietic cell transplantation (allo-HCT). In this open-label single-group pilot study, 18 subjects were enrolled before allo-HCT and planned to receive third-party FMT capsules. FMT capsules were administered no later than 4 weeks after neutrophil engraftment, and antibiotics were not allowed within 48 hours before FMT. Five patients did not receive FMT because of the development of early acute gastrointestinal (GI) graft-versus-host disease (GVHD) before FMT (n = 3), persistent HCT-associated GI toxicity (n = 1), or patient decision (n = 1). Thirteen patients received FMT at a median of 27 days (range, 19-45 days) after HCT. Participants were able to swallow and tolerate all FMT capsules, meeting the primary study endpoint of feasibility. FMT was tolerated well, with 1 treatment-related significant adverse event (abdominal pain). Two patients subsequently developed acute GI GVHD, with 1 patient also having concurrent bacteremia. No additional cases of bacteremia occurred. Median follow-up for survivors is 15 months (range, 13-20 months). The Kaplan-Meier estimates for 12-month overall survival and progression-free survival after FMT were 85% (95% confidence interval, 51%-96%) and 85% (95% confidence interval, 51%-96%), respectively. There was 1 nonrelapse death resulting from acute GI GVHD (12-month nonrelapse mortality, 8%; 95% confidence interval, 0%-30%). Analysis of stool composition and urine 3-indoxyl sulfate concentration indicated improvement in intestinal microbiome diversity after FMT that was associated with expansion of stool-donor taxa. These results indicate that empiric third-party FMT after allo-HCT appears to be feasible, safe, and associated with expansion of recipient microbiome diversity. This trial was registered at www.clinicaltrials.gov as #NCT02733744.
Collapse
Affiliation(s)
- Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Jonathan U Peled
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Shuli Li
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Zeina Dagher
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | - Ann E Slingerland
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Candice Del Rio
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Betsy Valles
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Maria E Kempner
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Melissa Smith
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Jami Brown
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Bimalangshu R Dey
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Areej El-Jawahri
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Steven L McAfee
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Thomas R Spitzer
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Karen K Ballen
- Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapies and
| | - Tara E Dalton
- Division of Hematologic Malignancies and Cellular Therapies and
| | - Julia A Messina
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
| | - Katja Dettmer
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Gerhard Liebisch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Peter Oefner
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Ying Taur
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Infectious Disease Service and Center for Microbes, Inflammation and Cancer, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric G Pamer
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Infectious Disease Service and Center for Microbes, Inflammation and Cancer, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ernst Holler
- Department of Hematology and Oncology, Internal Medicine III, University Medical Center, Regensburg, Germany; and
| | - Michael K Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | - Marcel R M van den Brink
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Elizabeth Hohmann
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | - Robert R Jenq
- Department of Genomic Medicine and
- Department of Stem Cell Transplantation Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yi-Bin Chen
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
30
|
DeAngelo DJ, Brunner AM, Werner L, Avigan D, Fathi AT, Sperling AS, Washington A, Stroopinsky D, Rosenblatt J, McMasters M, Luptakova K, Wadleigh M, Steensma DP, Hobbs GS, Attar EC, Amrein PC, Ebert BL, Stone RM, Ballen KK. A phase I study of lenalidomide plus chemotherapy with mitoxantrone, etoposide, and cytarabine for the reinduction of patients with acute myeloid leukemia. Am J Hematol 2018; 93:254-261. [PMID: 29119643 DOI: 10.1002/ajh.24968] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 10/27/2017] [Accepted: 11/06/2017] [Indexed: 12/17/2022]
Abstract
Patients with relapsed AML have a poor prognosis and limited responses to standard chemotherapy. Lenalidomide is an immunomodulatory drug that may modulate anti-tumor immunity. We performed a study to evaluate the safety and tolerability of lenalidomide with mitoxantrone, etoposide and cytarabine (MEC) in relapsed/refractory AML. Adult patients with relapsed/refractory AML were eligible for this phase I dose-escalation study. We enrolled 35 patients using a "3 + 3" design, with a 10 patient expansion cohort at the maximum tolerated dose (MTD). Lenalidomide was initially given days 1-14 and MEC days 4-8; due to delayed count recovery, the protocol was amended to administer lenalidomide days 1-10. The dose of lenalidomide was then escalated starting at 5 mg/d (5-10-25-50). The primary objective was tolerability and MTD determination, with secondary outcomes including overall survival (OS). The MTD of lenalidomide combined with MEC was 50 mg/d days 1-10. Among the 35 enrolled patients, 12 achieved complete remission (CR) (34%, 90%CI 21-50%); 30-day mortality was 6% and 60-day mortality 13%. The median OS for all patients was 11.5 months. Among 17 patients treated at the MTD, 7 attained CR (41%); the median OS was not reached while 12-month OS was 61%. Following therapy with MEC and lenalidomide, patient CD4+ and CD8+ T-cells demonstrated increased inflammatory responses to autologous tumor lysate. The combination of MEC and lenalidomide is tolerable with an RP2D of lenalidomide 50 mg/d days 1-10, yielding encouraging response rates. Further studies are planned to explore the potential immunomodulatory effect of lenalidomide and MEC.
Collapse
Affiliation(s)
| | | | | | - David Avigan
- Beth-Israel Deaconess Medical Center; Boston Massachusetts
| | - Amir T. Fathi
- Massachusetts General Hospital; Boston Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Fathi AT, Blonquist TM, Hernandez D, Amrein PC, Ballen KK, McMasters M, Avigan DE, Joyce R, Logan EK, Hobbs G, Brunner AM, Joseph C, Perry AM, Burke M, Behnan T, Foster J, Bergeron MK, Moran JA, Ramos AY, Som TT, Rae J, Fishman KM, McGregor KL, Connolly C, Neuberg DS, Levis MJ. Cabozantinib is well tolerated in acute myeloid leukemia and effectively inhibits the resistance-conferring FLT3/tyrosine kinase domain/F691 mutation. Cancer 2017; 124:306-314. [PMID: 28960265 DOI: 10.1002/cncr.31038] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cabozantinib, a tyrosine kinase inhibitor of FMS-like tyrosine kinase 3 (FLT3), MET, AXL, vascular endothelial growth factor receptor, and KIT, is approved for use in multiple malignancies. We assessed the safety and tolerability of cabozantinib in AML, given up-regulation of multiple relevant pathways. METHODS Adults were eligible if they were 18 years old or older with relapsed/refractory AML or if they were 70 years old or older with newly diagnosed AML but were ineligible for conventional therapy. Cabozantinib was administered in 28-day cycles, and dose escalation occurred via cohorts. A pharmacodynamic evaluation of serial plasma samples via a plasma inhibitory assay (PIA) was used to assess FLT3-inhibitory activity in FLT3-mutant cell lines. RESULTS Among 18 patients enrolled, 5 were found to harbor FLT3/ITD mutations. Sixteen patients (89%) had relapsed/refractory AML, and most were treated with 2 or more lines of prior treatment. No dose-limiting toxicities (DLTs) were detected at the first dose level (40 mg daily), but 2 patients experienced DLTs at the next level (60 mg daily). The remaining patients were then dosed at 40 mg daily, the maximum tolerated dose (MTD). Additional grade 2 or higher toxicities, possibly/probably related to cabozantinib, included fatigue, nausea, transaminitis, and electrolyte imbalance. No patients had a marrow response according to formal criteria, but 4 had peripheral blast reductions; 2 of these 4 patients transiently cleared circulating blasts. One patient experienced a reduction in marrow blasts, and 1 had stable disease. The FLT3-inhibitory activity of plasma samples, as assessed with the PIA, revealed potent and sustained inhibition in FLT3/ITD and, notably, F691 tyrosine kinase domain (TKD)-mutant cells. CONCLUSIONS Cabozantinib is well tolerated in AML patients at an MTD of 40 mg daily and is a potent inhibitor of FLT3/ITD- and F691 TKD-altered tyrosine kinases. Cancer 2018;124:306-14. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Amir T Fathi
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Traci M Blonquist
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Daniela Hernandez
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Philip C Amrein
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Karen K Ballen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Malgorzata McMasters
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - David E Avigan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robin Joyce
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Emma K Logan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gabriela Hobbs
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Andrew M Brunner
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Christelle Joseph
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Ashley M Perry
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Meghan Burke
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Tanya Behnan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Julia Foster
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Meghan K Bergeron
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Jenna A Moran
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Aura Y Ramos
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Tina T Som
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Jessica Rae
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn M Fishman
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Kristin L McGregor
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Christine Connolly
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Donna S Neuberg
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Mark J Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
32
|
Muffly L, Pasquini MC, Martens M, Brazauskas R, Zhu X, Adekola K, Aljurf M, Ballen KK, Bajel A, Baron F, Battiwalla M, Beitinjaneh A, Cahn JY, Carabasi M, Chen YB, Chhabra S, Ciurea S, Copelan E, D'Souza A, Edwards J, Foran J, Freytes CO, Fung HC, Gale RP, Giralt S, Hashmi SK, Hildebrandt GC, Ho V, Jakubowski A, Lazarus H, Luskin MR, Martino R, Maziarz R, McCarthy P, Nishihori T, Olin R, Olsson RF, Pawarode A, Peres E, Rezvani AR, Rizzieri D, Savani BN, Schouten HC, Sabloff M, Seftel M, Seo S, Sorror ML, Szer J, Wirk BM, Wood WA, Artz A. Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. Blood 2017; 130:1156-1164. [PMID: 28674027 PMCID: PMC5580273 DOI: 10.1182/blood-2017-03-772368] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [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: 03/14/2017] [Accepted: 06/19/2017] [Indexed: 12/20/2022] Open
Abstract
In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. The number and proportion of allografts performed in this population rose markedly over the past decade, accounting for 0.1% of transplants in 2000 to 3.85% (N = 298) in 2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications. Two-year OS and PFS significantly improved over time (OS: 26% [95% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.
Collapse
Affiliation(s)
- Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA
| | | | - Michael Martens
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research and
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI
| | - Xiaochun Zhu
- Center for International Blood and Marrow Transplant Research and
| | | | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | - Karen K Ballen
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Ashish Bajel
- Royal Melbourne Hospital, Victoria, VIC, Australia
| | - Frederic Baron
- Centre Hospitalier Universitaire de Liege, Domaine Universitaire du Sart Tilman, Liege, Belgium
| | - Minoo Battiwalla
- Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Amer Beitinjaneh
- Department of Hematology and Oncology, University of Miami, Miami, FL
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Mathew Carabasi
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Saurabh Chhabra
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Stefan Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy and
- Transplant Myeloid Study Group, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research and
| | - John Edwards
- Indiana Blood and Marrow Transplantation, Indianapolis, IN
| | | | | | - Henry C Fung
- Department of Medical Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shahrukh K Hashmi
- Department of Internal Medicine, Mayo Clinic, Minneapolis, MN
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gerhard C Hildebrandt
- Department of Internal Medicine, University of Kentucky Chandler Medical Center, Lexington, KY
| | - Vincent Ho
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Marlise R Luskin
- Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Rodrigo Martino
- Divison of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Richard Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Philip McCarthy
- Blood and Marrow Transplant Program, Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Rebecca Olin
- Department of Medicine, University of California San Francisco Medical Center, San Francisco, CA
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI
| | - Edward Peres
- Bone Marrow Transplant Program, Henry Ford Hospital, Detroit, MI
| | - Andrew R Rezvani
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Blood and Marrow Transplant Clinic, Duke University, Durham, NC
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, The Netherlands
| | - Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Sachiko Seo
- National Cancer Research Center, East Hospital, Kashiwa, Chiba, Japan
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Jeff Szer
- Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, VIC, Australia
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Andrew Artz
- Section of Hematology/Oncology, University of Chicago School of Medicine, Chicago, IL
| |
Collapse
|
33
|
Jalbut MM, Brunner AM, Amrein PC, Ballen KK, Hobbs GS, Perry AM, Joseph CP, Fathi AT. Early infectious complications among patients treated with induction compared to hypomethylating therapy for acute myeloid leukemia. Leuk Lymphoma 2017; 59:988-991. [PMID: 28792269 DOI: 10.1080/10428194.2017.1361028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marla M Jalbut
- a Division of Hematology/Oncology , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA.,b Tufts University School of Medicine , Boston , MA , USA
| | - Andrew M Brunner
- a Division of Hematology/Oncology , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Philip C Amrein
- a Division of Hematology/Oncology , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Karen K Ballen
- a Division of Hematology/Oncology , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Gabriela S Hobbs
- a Division of Hematology/Oncology , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Ashley M Perry
- a Division of Hematology/Oncology , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Christelle P Joseph
- a Division of Hematology/Oncology , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Amir T Fathi
- a Division of Hematology/Oncology , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| |
Collapse
|
34
|
Alonso CD, Braun DA, Patel I, Akbari M, Oh DJ, Jun T, McMasters M, Hammond SP, Glotzbecker B, Cutler C, Leffler DA, Ballen KK, Kelly CP. A multicenter, retrospective, case-cohort study of the epidemiology and risk factors for Clostridium difficile infection among cord blood transplant recipients. Transpl Infect Dis 2017; 19. [PMID: 28544102 DOI: 10.1111/tid.12728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is the leading cause of health-care associated infectious diarrhea. The aim of this study was to evaluate the epidemiology and risk factors for CDI in the 100 days following umbilical cord blood transplantation (UCBT) at three Boston hospitals. METHODS We performed a multicenter, retrospective, case-cohort study of 226 UCBT recipients at Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Dana Farber/Brigham and Women's Cancer Center from 2003 to 2012. CDI was defined as diarrhea (≥3 unformed bowel movements for at least 2 days) plus a positive stool test for toxinogenic C. difficile and not attributed to any other cause. RESULTS Among 226 UCBT recipients, 22 patients (9.7%) developed CDI within the first 100 days of transplant (corresponding to an infection rate of 10.8 cases per 10 000 person-days). The 100-day and 1-year rates were stable across the time period and between institutions. UCBT recipients with CDI were more likely than non-CDI patients to be older, with higher body mass indices, and to have received an antipseudomonal penicillin agent. In a time-dependent case-cohort analysis of the risk factors associated with CDI in the first 100 days after UCBT, bacterial infection after UCBT was the strongest risk factor for CDI (hazard ratio 2.8; 95% confidence interval 1.08-7.24; P=.03), after adjustment for transplant variables including antibiotic exposure. CONCLUSION This study verifies the previously reported risk factors for CDI including older age and antibiotic exposure and identifies a novel association between bacterial infections and risk for CDI.
Collapse
Affiliation(s)
- Carolyn D Alonso
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - David A Braun
- Dana-Farber/Partners CancerCare Program, Boston, MA, USA
| | - Ishan Patel
- Department of Medicine, Icahn School of Medicine, Elmhurst Program, New York, NY, USA
| | - Mona Akbari
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel Jungmyung Oh
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tomi Jun
- Stanford Health Care, Stanford, CA, USA
| | - Malgorzata McMasters
- Section of Hematological Malignancies and Bone Marrow Transplantation, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sarah P Hammond
- Harvard Medical School, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Brett Glotzbecker
- Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | - Corey Cutler
- Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel A Leffler
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Karen K Ballen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Ciarán P Kelly
- Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
35
|
Kindwall-Keller TL, Ballen KK. Alternative Donor Graft Sources for Adults with Hematologic Malignancies: A Donor for All Patients in 2017! Oncologist 2017; 22:1125-1134. [PMID: 28546462 DOI: 10.1634/theoncologist.2017-0009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 01/10/2017] [Accepted: 04/13/2017] [Indexed: 12/21/2022] Open
Abstract
Hematopoietic stem cell transplant (HSCT) is potentially curative for a wide variety of malignant diseases, including acute and leukemias, lymphoma, and myelodysplasia. Choice of a stem cell donor is dependent on donor availability, donor compatibility and health, recipient disease type, and recipient condition. Current sources of stem cell donation for HSCT are matched sibling donors (MSDs), matched unrelated donors (MUDs), 1-antigen mismatched unrelated donors (MMUDs), haploidentical donors (haplo), and umbilical cord blood (UCB) units. Historically, preferred donors for HSCT have been human leukocyte antigen (HLA)-matched sibling donors; however, only about 30% of U.S. patients will have a MSD available. The majority of patients referred for HSCT will require an alternative donor graft: MUD, MMUD, UCB, or haplo. The likelihood of finding a MUD varies depending on the ethnicity of the recipient. White Caucasians of European descent have the greatest chance of finding a MUD. Chances of finding a MUD are significantly less for African-American or Hispanic recipients due to HLA polymorphisms. Therefore, MMUD, UCB, and haplo donor graft sources expand the donor pool for recipients who do not have a MSD or MUD available. Given the variety of different donor stem cell sources available today, nearly every patient who needs an allogeneic HSCT has a potential donor in 2017. All transplant-eligible patients with hematologic malignancies should be evaluated by a transplant center to determine if HSCT is a viable treatment option for their underlying disease process. IMPLICATIONS FOR PRACTICE The goal of this review is to increase the awareness of oncology practitioners to the availability of alternative donor stem cell transplants for patients with hematologic malignancies. Despite new agents, stem cell transplant remains the only curative therapy for many patients with acute and chronic leukemia, myelodysplasia, and lymphoma. Given the variety of different donor stem cell sources available today, nearly every patient who needs an allogeneic stem cell transplant will have a donor.
Collapse
Affiliation(s)
- Tamila L Kindwall-Keller
- Department of Medicine, University of Virginia School of Medicine, and Stem Cell Transplant Program, University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Karen K Ballen
- Department of Medicine, University of Virginia School of Medicine, and Stem Cell Transplant Program, University of Virginia Cancer Center, Charlottesville, Virginia, USA
| |
Collapse
|
36
|
Perry AM, Brunner AM, Zou T, McGregor KL, Amrein PC, Hobbs GS, Ballen KK, Neuberg DS, Fathi AT. Association between insurance status at diagnosis and overall survival in chronic myeloid leukemia: A population-based study. Cancer 2017; 123:2561-2569. [PMID: 28464280 DOI: 10.1002/cncr.30639] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Chronic myeloid leukemia (CML) can be treated effectively with tyrosine kinase inhibitor therapy directed at BCR-ABL, but access to care, medication cost, and adherence may be barriers to treatment. This study was designed to determine whether the insurance status at diagnosis influences CML patient outcomes. METHODS The Surveillance, Epidemiology, and End Results database was used to identify 5784 patients, aged 15 years or older, who were diagnosed with CML between 2007 and 2012 and whose insurance status was documented at diagnosis. The primary outcome was 5-year overall survival (OS). Covariates of interest included the age at diagnosis, race, ethnicity, sex, county-level socioeconomic status, and marital status. OS was evaluated with a log-rank test and Kaplan-Meier estimates. RESULTS Among patients aged 15 to 64 years, insurance status was associated with OS (P < .001): being uninsured or having Medicaid was associated with worse 5-year OS in comparison with being insured (uninsured patients, 72.7%; Medicaid patients, 73.1%; insured patients, 86.6%). For patients who were 65 years old or older, insurance had less of an impact on OS (P = .07), with similar 5-year OS rates for patients with Medicaid and those with other insurance (40.2% vs 43.4%). In a multivariate analysis of patients aged 15 to 64 years, both uninsured patients (hazard ratio [HR], 1.93; P < .001) and Medicaid patients (HR, 1.83; P < .001) had an increased hazard of death in comparison with insured patients; patients younger than 40 years, female patients, and married patients also had a lower hazard of death. CONCLUSION These findings suggest that CML patients under the age of 65 years who are uninsured or have Medicaid have significantly worse survival than patients with other insurance coverage. Cancer 2017;123:2561-69. © 2017 American Cancer Society.
Collapse
Affiliation(s)
| | | | - Tao Zou
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | | | - Amir T Fathi
- Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
37
|
Gerds AT, Woo Ahn K, Hu ZH, Abdel-Azim H, Akpek G, Aljurf M, Ballen KK, Beitinjaneh A, Bacher U, Cahn JY, Chhabra S, Cutler C, Daly A, DeFilipp Z, Gale RP, Gergis U, Grunwald MR, Hale GA, Hamilton BK, Jagasia M, Kamble RT, Kindwall-Keller T, Nishihori T, Olsson RF, Ramanathan M, Saad AA, Solh M, Ustun C, Valcárcel D, Warlick E, Wirk BM, Kalaycio M, Alyea E, Popat U, Sobecks R, Saber W. Outcomes after Umbilical Cord Blood Transplantation for Myelodysplastic Syndromes. Biol Blood Marrow Transplant 2017; 23:971-979. [PMID: 28288952 DOI: 10.1016/j.bbmt.2017.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/08/2017] [Indexed: 11/19/2022]
Abstract
For patients with hematologic malignancies undergoing allogeneic hematopoietic cell transplantation, umbilical cord blood transplantation (UCBT) has become an acceptable alternative donor source in the absence of a matched sibling or unrelated donor. To date, however, there have been few published series dedicated solely to describing the outcomes of adult patients with myelodysplastic syndrome (MDS) who have undergone UCBT. Between 2004 and 2013, 176 adults with MDS underwent UCBT as reported to the Center for International Blood and Marrow Transplant Research. Median age at the time of transplantation was 56 years (range, 18-73 years). The study group included 10% with very low, 23% with low, 19% with intermediate, 19% with high, and 13% with very high-risk Revised International Prognostic Scoring System (IPSS-R) scores. The 100-day probability of grade II-IV acute graft-versus-host disease (GVHD) was 38%, and the 3-year probability of chronic GVHD was 28%. The probabilities of relapse and transplantation-related mortality (TRM) at 3 years were 32% and 40%, respectively, leading to a 3-year disease-free survival (DFS) of 28% and an overall survival (OS) of 31%. In multivariate analysis, increasing IPSS-R score at the time of HCT was associated with inferior TRM (P = .0056), DFS (P = .018), and OS (P = .0082), but not with GVHD or relapse. The presence of pretransplantation comorbidities was associated with TRM (P = .001), DFS (P = .02), and OS (P = .001). Reduced-intensity conditioning was associated with increased risk of relapse (relative risk, 3.95; 95% confidence interval, 1.78-8.75; P < .001), and although a higher proportion of myeloablative UCBTs were performed in patients with high-risk disease, the effect of conditioning regimen intensity was the same regardless of IPSS-R score. For some individuals who lack a matched sibling or unrelated donor, UCBT can result in long-term DFS; however, the success of UCBT in this population is hampered by a high rate of TRM.
Collapse
Affiliation(s)
- Aaron T Gerds
- Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhen-Huan Hu
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Gorgun Akpek
- Stem Cell Transplantation and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Karen K Ballen
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Amer Beitinjaneh
- Division of Hematology and Oncology, University of Miami, Miami, Florida
| | - Ulrike Bacher
- Department of Hematology, Inselspital Bern, Bern, Switzerland; Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Saurabh Chhabra
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Corey Cutler
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Zachariah DeFilipp
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | | | - Gregory A Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Betty Ky Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Madan Jagasia
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Muthalagu Ramanathan
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Ayman A Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Celalettin Ustun
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - David Valcárcel
- Department of Hematology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Erica Warlick
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Matt Kalaycio
- Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edwin Alyea
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Uday Popat
- M.D. Anderson Cancer Center, Houston, Texas
| | - Ronald Sobecks
- Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
38
|
Ballen KK, Logan BR, Chitphakdithai P, Spellman S, Adams AJ, Drexler RJ, Duffy M, Kemp A, King RJ, Delaney C, Shpall EJ, Kurtzberg J, Babic A, Confer DL, Miller JP. Excellent Outcomes in 1589 Patients Receiving Umbilical Cord Blood Transplantation Using Unlicensed Units From a Centralized Cord Blood Registry. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
39
|
DeFilipp Z, Nazarian RM, Li S, Brown J, Ballen KK, El-Jawahri AR, McAfee SL, Antin JH, Cutler CS, Rosenblatt J, Chen YB. Sonidegib (LDE-225), a Sonic Hedgehog Pathway Inhibitor, for the Treatment of Steroid-Refractory Chronic Graft-Versus-Host Disease. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
Fathi AT, Wander SA, Blonquist TM, Brunner AM, Amrein PC, Supko J, Hermance NM, Manning AL, Sadrzadeh H, Ballen KK, Attar EC, Graubert TA, Hobbs G, Joseph C, Perry AM, Burke M, Silver R, Foster J, Bergeron M, Ramos AY, Som TT, Fishman KM, McGregor KL, Connolly C, Neuberg DS, Chen YB. Phase I study of the aurora A kinase inhibitor alisertib with induction chemotherapy in patients with acute myeloid leukemia. Haematologica 2016; 102:719-727. [PMID: 28034990 PMCID: PMC5395112 DOI: 10.3324/haematol.2016.158394] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/26/2016] [Indexed: 12/17/2022] Open
Abstract
Aberrant expression of aurora kinase A is implicated in the genesis of various
neoplasms, including acute myeloid leukemia. Alisertib, an aurora A kinase
inhibitor, has demonstrated efficacy as monotherapy in trials of myeloid
malignancy, and this efficacy appears enhanced in combination with conventional
chemotherapies. In this phase I, dose-escalation study, newly diagnosed patients
received conventional induction with cytarabine and idarubicin, after which
alisertib was administered for 7 days. Dose escalation occurred
via cohorts. Patients could then receive up to four cycles
of consolidation, incorporating alisertib, and thereafter alisertib maintenance
for up to 12 months. Twenty-two patients were enrolled. One dose limiting
toxicity occurred at dose level 2 (prolonged thrombocytopenia), and the
recommended phase 2 dose was established at 30mg twice daily. Common
therapy-related toxicities included cytopenias and mucositis. Only three
(14%) patients had persistent disease at mid-cycle, requiring
“5+2” reinduction. The composite remission rate (complete
remission and complete remission with incomplete neutrophil recovery) was
86% (nineteen of twenty-two patients; 90% CI
68–96%). Among those over age 65 and those with high-risk
disease (secondary acute leukemia or cytogenetically high-risk disease), the
composite remission rate was 88% and 100%, respectively. The
median follow up was 13.5 months. Of those treated at the recommended phase 2
dose, the 12-month overall survival and progression-free survival were
62% (90% CI 33–81%) and 42% (90%
CI 17–65%), respectively. Alisertib is well tolerated when
combined with induction chemotherapy in acute myeloid leukemia, with a promising
suggestion of efficacy. (clinicaltrials.gov Identifier:01779843).
Collapse
Affiliation(s)
- Amir T Fathi
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Seth A Wander
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | | | - Andrew M Brunner
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Philip C Amrein
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Jeffrey Supko
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Nicole M Hermance
- Worcester Polytechnic Institute, Department of Biology, Worcester, MA, USA
| | - Amity L Manning
- Worcester Polytechnic Institute, Department of Biology, Worcester, MA, USA
| | - Hossein Sadrzadeh
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Karen K Ballen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Eyal C Attar
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Timothy A Graubert
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Gabriela Hobbs
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Christelle Joseph
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Ashley M Perry
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Meghan Burke
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Regina Silver
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Julia Foster
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Meghan Bergeron
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Aura Y Ramos
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Tina T Som
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Kaitlyn M Fishman
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Kristin L McGregor
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Christine Connolly
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Donna S Neuberg
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Yi-Bin Chen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| |
Collapse
|
41
|
Brunstein CG, Cutler CS, DeFor TE, Kim H, Bejanyan N, Garfall A, Verneris MR, Chen YB, Warlick ED, Spitzer T, Miller JS, Antin JH, Weisdorf DJ, Soiffer R, Wagner JE, Ballen KK. Matching at Human Leukocyte Antigen-C Improved the Outcomes after Double Umbilical Cord Blood Transplantation for Recipients of Two to Four of Six Human Leukocyte Antigen-Matched Grafts. Biol Blood Marrow Transplant 2016; 23:126-133. [PMID: 27989929 DOI: 10.1016/j.bbmt.2016.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Abstract
We studied the effect of HLA-C matching in 515 patients after double umbilical cord blood (UCB) transplantation. After HLA matching HLA-A, -B, and -DRB1 at the allele level, we scored patients according to number of donor-recipient HLA-C matches at 4 possible loci: 2 from each donor unit, at the allele level. Given a direct interaction between HLA-A, -B, and -DRB1 matching and HLA-C score, we analyzed HLA-C matching in those receiving at least 1 2/6 to 4/6 HLA-matched unit (n = 389) versus those receiving only 5/6 or 6/6-matched units (n = 126). In those with at least 1 2/6 to 4/6 HLA-matched unit, a better HLA-C matching score was associated with significantly lower risk of death of any cause and nonrelapse mortality and better disease-free survival. There was no association with the risk of relapse, acute and chronic graft-versus-host disease, and hematopoietic recovery. In contrast, among patients receiving only allele-level 5/6 or 6/6 HLA-matched UCB units, HLA-C match had no demonstrable effect on any outcome. For patients receiving at least 1 allele-level 2/6 to 4/6 HLA-matched UCB unit, matching at HLA-C reduces nonrelapse mortality and improves survival.
Collapse
Affiliation(s)
- Claudio G Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
| | | | - Todd E DeFor
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Haesook Kim
- The Dana Farber Cancer Institute, Boston, Massachusetts
| | - Nelli Bejanyan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | | | - Michael R Verneris
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Yi-Bin Chen
- Massachusetts General Hospital, Boston, Massachusetts
| | - Erica D Warlick
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | | | - Jeffrey S Miller
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | | | - Daniel J Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | | | - John E Wagner
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | | |
Collapse
|
42
|
Politikos I, T Kim H, Karantanos T, Brown J, McDonough S, Li L, Cutler C, Antin JH, Ballen KK, Ritz J, Boussiotis VA. Angiogenic Factors Correlate with T Cell Immune Reconstitution and Clinical Outcomes after Double-Unit Umbilical Cord Blood Transplantation in Adults. Biol Blood Marrow Transplant 2016; 23:103-112. [PMID: 27777141 DOI: 10.1016/j.bbmt.2016.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 10/15/2016] [Indexed: 11/18/2022]
Abstract
Umbilical cord blood (UCB) is a valuable graft source for allogeneic hematopoietic stem cell transplantation (HSCT) in patients who lack adult donors. UCB transplantation (UCBT) in adults results in delayed immune reconstitution, leading to high infection-related morbidity and mortality. Angiogenic factors and markers of endothelial dysfunction have biologic and prognostic significance in conventional HSCT, but their role in UCBT has not been investigated. Furthermore, the interplay between angiogenesis and immune reconstitution has not been studied. Here we examined whether angiogenic cytokines, angiopoietin-1 (ANG-1) and vascular endothelial growth factor (VEGF), or markers of endothelial injury, thrombomodulin (TM) and angiopoietin-2 (ANG-2), associate with thymic regeneration as determined by T cell receptor excision circle (TREC) values and recovery of T cell subsets, as well as clinical outcomes in adult recipients of UCBT. We found that plasma levels of ANG-1 significantly correlated with the reconstitution of naive CD4+CD45RA+ and CD8+CD45RA+ T cell subsets, whereas plasma levels of VEGF displayed a positive correlation with CD4+CD45RO+ T cells and regulatory T cells and a weak correlation with TRECs. Assessment of TM and ANG-2 revealed a strong inverse correlation of both factors with naive T cells and TRECs. The angiogenic capacity of each patient's plasma, as determined by an in vitro angiogenesis assay, positively correlated with VEGF levels and with reconstitution of CD4+ T cell subsets. Higher VEGF levels were associated with worse progression-free survival and higher risk of relapse, whereas higher levels of TM were associated with chronic graft-versus-host disease and nonrelapse mortality. Thus, angiogenic factors may serve as valuable markers associated with T cell reconstitution and clinical outcomes after UCBT.
Collapse
Affiliation(s)
- Ioannis Politikos
- Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Haesook T Kim
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Theodoros Karantanos
- Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Julia Brown
- Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sean McDonough
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lequn Li
- Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Corey Cutler
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Karen K Ballen
- Bone Marrow Transplant Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Jerome Ritz
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vassiliki A Boussiotis
- Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
43
|
Wolach O, Stevenson KE, Wadleigh M, DeAngelo DJ, Steensma DP, Ballen KK, Soiffer RJ, Antin JH, Neuberg DS, Ho VT, Stone RM. Allogeneic transplantation is not superior to chemotherapy in most patients over 40 years of age with Philadelphia-negative acute lymphoblastic leukemia in first remission. Am J Hematol 2016; 91:793-9. [PMID: 27153389 DOI: 10.1002/ajh.24410] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 01/09/2023]
Abstract
Survival of patients ≥40 years of age with Philadelphia-negative acute lymphoblastic leukemia (ALL) remains poor with current therapeutic approaches. It is unknown whether allogeneic hematopoietic stem-cell transplantation (HSCT) in first remission confers a survival benefit compared to a chemotherapy-only approach. We retrospectively compared the outcome of patients >40 years treated with HSCT or chemotherapy alone in first remission (n = 40 in each cohort). Three-year overall survival (OS) and disease-free survival (DFS) were not significantly different between the chemotherapy-only and HSCT groups (OS, 46% [31-68] vs. 40% [27-59], P = 0.35; DFS, 31% [18-52] vs. 40% [27-59], P = 0.98). The 3-year cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) were 61% [41-76] and 9% [2-21] for the chemotherapy-only group and 28% [15-43] and 32% [17-47] for the transplant group (CIR, P = 0.011; NRM, P = 0.014). Allogeneic transplantation for patients ≥40 years with Ph-negative ALL in first remission is associated with a lower CIR, but this benefit is offset by considerable NRM as compared with chemotherapy-only approach. HSCT may be beneficial in patients with high-risk disease features. Am. J. Hematol. 91:793-799, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ofir Wolach
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Kristen E. Stevenson
- Department of Biostatistics and Computational Biology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Martha Wadleigh
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Daniel J. DeAngelo
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - David P. Steensma
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Karen K. Ballen
- Department of Hematology/Oncology; Massachusetts General Hospital; Boston Massachusetts
| | - Robert J. Soiffer
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Joseph H. Antin
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Donna S. Neuberg
- Department of Biostatistics and Computational Biology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Vincent T. Ho
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Richard M. Stone
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| |
Collapse
|
44
|
Brunner AM, Li S, Fathi AT, Wadleigh M, Ho VT, Collier K, Connolly C, Ballen KK, Cutler CS, Dey BR, El-Jawahri A, Nikiforow S, McAfee SL, Koreth J, Deangelo DJ, Alyea EP, Antin JH, Spitzer TR, Stone RM, Soiffer RJ, Chen YB. Haematopoietic cell transplantation with and without sorafenib maintenance for patients with FLT3-ITD acute myeloid leukaemia in first complete remission. Br J Haematol 2016; 175:496-504. [PMID: 27434660 DOI: 10.1111/bjh.14260] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/07/2016] [Indexed: 01/19/2023]
Abstract
We performed a retrospective study analysing the effect of sorafenib, an oral fms-Like Tyrosine Kinase 3 (FLT3)/multikinase inhibitor, as post-transplant maintenance in adult patients with FLT3-internal tandem duplication (ITD) acute myeloid leukaemia (AML). We identified consecutive patients with FLT3-ITD AML diagnosed between 2008 and 2014 who received haematopoietic cell transplantation (HCT) in first complete remission (CR1). Post-HCT initiation of sorafenib (yes/no) was evaluated as a time-varying covariate in the overall survival/progression-free survival (OS/PFS) analysis and we performed a landmark analysis of controls alive without relapse at the median date of sorafenib initiation. We identified 26 sorafenib patients and 55 controls. Median follow-up was 27·2 months post-HCT for sorafenib survivors, and 38·4 months for controls (P = 0·021). The median time to initiating sorafenib was 68 days post-HCT; 43 controls were alive without relapse at this cut-off. Sorafenib patients had improved 2-year OS in the d+68 landmark analysis (81% vs. 62%, P = 0·029). Sorafenib was associated with improved 2-year PFS (82% vs. 53%, P = 0·0081) and lower 2-year cumulative incidence of relapse (8·2% vs. 37·7%, P = 0·0077). In multivariate analysis, sorafenib significantly improved OS [Hazard ratio (HR) 0·26, P = 0·021] and PFS (HR 0·25, P = 0·016). There was no difference in 2-year non-relapse mortality (9·8% vs. 9·3%, P = 0·82) or 1-year chronic graft-versus-host disease (55·5% vs. 37·2%, P = 0·28). These findings suggest potential benefit of post-HCT sorafenib in FLT3-ITD AML, and support further evaluation of post-HCT FLT3 inhibition.
Collapse
Affiliation(s)
- Andrew M Brunner
- Massachusetts General Hospital, Boston, MA, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shuli Li
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | | | | | - John Koreth
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | | | | | - Yi-Bin Chen
- Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
45
|
Townsend EC, Murakami MA, Christodoulou A, Christie AL, Köster J, DeSouza TA, Morgan EA, Kallgren SP, Liu H, Wu SC, Plana O, Montero J, Stevenson KE, Rao P, Vadhi R, Andreeff M, Armand P, Ballen KK, Barzaghi-Rinaudo P, Cahill S, Clark RA, Cooke VG, Davids MS, DeAngelo DJ, Dorfman DM, Eaton H, Ebert BL, Etchin J, Firestone B, Fisher DC, Freedman AS, Galinsky IA, Gao H, Garcia JS, Garnache-Ottou F, Graubert TA, Gutierrez A, Halilovic E, Harris MH, Herbert ZT, Horwitz SM, Inghirami G, Intlekofer AM, Ito M, Izraeli S, Jacobsen ED, Jacobson CA, Jeay S, Jeremias I, Kelliher MA, Koch R, Konopleva M, Kopp N, Kornblau SM, Kung AL, Kupper TS, LeBoeuf NR, LaCasce AS, Lees E, Li LS, Look AT, Murakami M, Muschen M, Neuberg D, Ng SY, Odejide OO, Orkin SH, Paquette RR, Place AE, Roderick JE, Ryan JA, Sallan SE, Shoji B, Silverman LB, Soiffer RJ, Steensma DP, Stegmaier K, Stone RM, Tamburini J, Thorner AR, van Hummelen P, Wadleigh M, Wiesmann M, Weng AP, Wuerthner JU, Williams DA, Wollison BM, Lane AA, Letai A, Bertagnolli MM, Ritz J, Brown M, Long H, Aster JC, Shipp MA, Griffin JD, Weinstock DM. The Public Repository of Xenografts Enables Discovery and Randomized Phase II-like Trials in Mice. Cancer Cell 2016; 30:183. [PMID: 27479034 DOI: 10.1016/j.ccell.2016.06.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
46
|
El-Jawahri A, Keenan T, Abel GA, Steensma DP, LeBlanc TW, Chen YB, Hobbs G, Traeger L, Fathi AT, DeAngelo DJ, Wadleigh M, Ballen KK, Amrein PC, Stone RM, Temel JS. Potentially avoidable hospital admissions in older patients with acute myeloid leukaemia in the USA: a retrospective analysis. The Lancet Haematology 2016; 3:e276-83. [DOI: 10.1016/s2352-3026(16)30024-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 02/07/2023]
|
47
|
Fathi AT, DeAngelo DJ, Stevenson KE, Kolitz JE, Asch JD, Amrein PC, Attar EC, Steensma DP, Wadleigh M, Foster J, Connolly C, Galinsky I, Devoe CE, Stone RM, Neuberg DS, Ballen KK. Phase 2 study of intensified chemotherapy and allogeneic hematopoietic stem cell transplantation for older patients with acute lymphoblastic leukemia. Cancer 2016; 122:2379-88. [DOI: 10.1002/cncr.30037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/03/2016] [Accepted: 03/16/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Amir T. Fathi
- Massachusetts General Hospital Cancer Center; Boston Massachusetts
| | | | | | - Jonathan E. Kolitz
- Monter Cancer Center; North Shore-Long Island Jewish Health System; Lake Success New York
| | | | - Philip C. Amrein
- Massachusetts General Hospital Cancer Center; Boston Massachusetts
| | - Eyal C. Attar
- Massachusetts General Hospital Cancer Center; Boston Massachusetts
| | | | | | - Julia Foster
- Massachusetts General Hospital Cancer Center; Boston Massachusetts
| | | | | | - Craig E. Devoe
- Monter Cancer Center; North Shore-Long Island Jewish Health System; Lake Success New York
| | | | | | - Karen K. Ballen
- Massachusetts General Hospital Cancer Center; Boston Massachusetts
| |
Collapse
|
48
|
Townsend EC, Murakami MA, Christodoulou A, Christie AL, Köster J, DeSouza TA, Morgan EA, Kallgren SP, Liu H, Wu SC, Plana O, Montero J, Stevenson KE, Rao P, Vadhi R, Andreeff M, Armand P, Ballen KK, Barzaghi-Rinaudo P, Cahill S, Clark RA, Cooke VG, Davids MS, DeAngelo DJ, Dorfman DM, Eaton H, Ebert BL, Etchin J, Firestone B, Fisher DC, Freedman AS, Galinsky IA, Gao H, Garcia JS, Garnache-Ottou F, Graubert TA, Gutierrez A, Halilovic E, Harris MH, Herbert ZT, Horwitz SM, Inghirami G, Intlekofer AM, Ito M, Izraeli S, Jacobsen ED, Jacobson CA, Jeay S, Jeremias I, Kelliher MA, Koch R, Konopleva M, Kopp N, Kornblau SM, Kung AL, Kupper TS, LeBoeuf NR, LaCasce AS, Lees E, Li LS, Look AT, Murakami M, Muschen M, Neuberg D, Ng SY, Odejide OO, Orkin SH, Paquette RR, Place AE, Roderick JE, Ryan JA, Sallan SE, Shoji B, Silverman LB, Soiffer RJ, Steensma DP, Stegmaier K, Stone RM, Tamburini J, Thorner AR, van Hummelen P, Wadleigh M, Wiesmann M, Weng AP, Wuerthner JU, Williams DA, Wollison BM, Lane AA, Letai A, Bertagnolli MM, Ritz J, Brown M, Long H, Aster JC, Shipp MA, Griffin JD, Weinstock DM. The Public Repository of Xenografts Enables Discovery and Randomized Phase II-like Trials in Mice. Cancer Cell 2016; 29:574-586. [PMID: 27070704 PMCID: PMC5177991 DOI: 10.1016/j.ccell.2016.03.008] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/25/2016] [Accepted: 03/11/2016] [Indexed: 01/22/2023]
Abstract
More than 90% of drugs with preclinical activity fail in human trials, largely due to insufficient efficacy. We hypothesized that adequately powered trials of patient-derived xenografts (PDX) in mice could efficiently define therapeutic activity across heterogeneous tumors. To address this hypothesis, we established a large, publicly available repository of well-characterized leukemia and lymphoma PDXs that undergo orthotopic engraftment, called the Public Repository of Xenografts (PRoXe). PRoXe includes all de-identified information relevant to the primary specimens and the PDXs derived from them. Using this repository, we demonstrate that large studies of acute leukemia PDXs that mimic human randomized clinical trials can characterize drug efficacy and generate transcriptional, functional, and proteomic biomarkers in both treatment-naive and relapsed/refractory disease.
Collapse
Affiliation(s)
- Elizabeth C Townsend
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Mark A Murakami
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Alexandra Christodoulou
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Amanda L Christie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Johannes Köster
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA; Center for Functional Cancer Epigenomics, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Tiffany A DeSouza
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Elizabeth A Morgan
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Scott P Kallgren
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, USA
| | - Huiyun Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Shuo-Chieh Wu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Olivia Plana
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Joan Montero
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Kristen E Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Prakash Rao
- Center for Functional Cancer Epigenomics, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Raga Vadhi
- Center for Functional Cancer Epigenomics, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Michael Andreeff
- Leukemia Division, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Karen K Ballen
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Patrizia Barzaghi-Rinaudo
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Sarah Cahill
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Rachael A Clark
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Vesselina G Cooke
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - David M Dorfman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Hilary Eaton
- Office of Research and Technology Ventures, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Benjamin L Ebert
- Department of Hematology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Julia Etchin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Brant Firestone
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - David C Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Arnold S Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Ilene A Galinsky
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Hui Gao
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Jacqueline S Garcia
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | | | - Timothy A Graubert
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alejandro Gutierrez
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA 02215, USA; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Ensar Halilovic
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Marian H Harris
- Department of Pathology, Boston Children's Hospital, Boston, MA 02215, USA
| | - Zachary T Herbert
- Molecular Biology Core Facility, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Steven M Horwitz
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Giorgio Inghirami
- Department of Pathology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Andrew M Intlekofer
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Moriko Ito
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Shai Izraeli
- Functional Genomics and Leukemia Research, Sheba Medical Center, Tel Hashomer and Tel Aviv University, Ramat Gan, 52621, Israel
| | - Eric D Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Sébastien Jeay
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Irmela Jeremias
- Department of Gene Vectors, Helmholtz Zentrum München, German Research Center for Environmental Health, Marchioninistraße 25, 81377 Munich, Germany; Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, Lindwurmstraße 4, 80337 Munich, Germany
| | - Michelle A Kelliher
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Raphael Koch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Marina Konopleva
- Leukemia Division, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nadja Kopp
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Steven M Kornblau
- Leukemia Division, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Andrew L Kung
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Ann S LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Emma Lees
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Loretta S Li
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - A Thomas Look
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Masato Murakami
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Markus Muschen
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Donna Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Samuel Y Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Oreofe O Odejide
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Stuart H Orkin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Rachel R Paquette
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Andrew E Place
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Justine E Roderick
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Jeremy A Ryan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Stephen E Sallan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Brent Shoji
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Robert J Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - David P Steensma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Kimberly Stegmaier
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Jerome Tamburini
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, 75005 Paris, France
| | - Aaron R Thorner
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Paul van Hummelen
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Martha Wadleigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Marion Wiesmann
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Andrew P Weng
- Department of Pathology, British Columbia Cancer Research Center, Vancouver V5Z 1H8, Canada
| | - Jens U Wuerthner
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA; Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - David A Williams
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Bruce M Wollison
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Andrew A Lane
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Anthony Letai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Monica M Bertagnolli
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jerome Ritz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - Myles Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA; Center for Functional Cancer Epigenomics, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Henry Long
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA; Center for Functional Cancer Epigenomics, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jon C Aster
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Margaret A Shipp
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - James D Griffin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA
| | - David M Weinstock
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 450 Brookline Avenue, Dana 510B, MA 02215, USA; Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA.
| |
Collapse
|
49
|
Abstract
Umbilical cord blood is a haematopoietic progenitor cell source for patients with acute myeloid leukaemia (AML), other haematological malignancies and metabolic diseases who can be cured by allogeneic haematopoietic cell transplantation, but who do not have a human leucocyte antigen compatible related or unrelated donor. Although the first cord blood transplants were done in children, there are currently more cord blood transplants performed in adults. In this review, we explore the history of umbilical cord blood transplantation, paediatric and adult outcome results, and novel trends to improve engraftment and reduce infection. Umbilical cord blood transplantation cures approximately 30-40% of adults and 60-70% of children with AML. Controversial issues, including the use of double versus single cord blood units for transplantation, optimal cord blood unit selection, infection prophylaxis, conditioning regimens and graft versus host disease prophylaxis, will be reviewed. Finally, comparison to other graft sources, cost, access to care, and the ideal graft source are discussed.
Collapse
Affiliation(s)
- Karen K Ballen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Hillard Lazarus
- Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
50
|
El-Jawahri A, Li S, Antin JH, Spitzer TR, Armand PA, Koreth J, Nikiforow S, Ballen KK, Ho VT, Alyea EP, Dey BR, McAfee SL, Glotzbecker BE, Soiffer RJ, Cutler CS, Chen YB. Improved Treatment-Related Mortality and Overall Survival of Patients with Grade IV Acute GVHD in the Modern Years. Biol Blood Marrow Transplant 2015; 22:910-8. [PMID: 26748160 DOI: 10.1016/j.bbmt.2015.12.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/26/2015] [Indexed: 11/20/2022]
Abstract
The impact of advances in supportive care and hematopoietic stem cell transplantation (HSCT) practices on the outcomes of patients who develop grade III or IV acute graft-versus-host disease (GVHD) is unknown. We performed a retrospective analysis of 427 patients with overall grade III or IV acute GVHD treated at 2 partner institutions between 1997 and 2012. We compared treatment-related mortality (TRM) and overall survival (OS) in 2 cohorts based on the year of transplantation, 1997 to 2006 (n = 222) and 2007 to 2012 (n = 205), using multivariate analysis, adjusting for significant patient-, disease-, and transplantation-related factors. Recipient age, reduced-intensity conditioning, unrelated donor, and peripheral blood stem cell grafts in the patients with grade III or IV acute GVHD increased over time. In the unadjusted analysis, 12-month OS increased over time (30% in 1997 to 2006 versus 42% in 2007 to 2012; P = .003) reflecting a decrease in TRM (58% in 1997 to 2006 versus 38% in 2007 to 2012; P = .0002), and an increase in PFS (29% in 1997 to 2006 versus 43% in 2007 to 2012; P = .002). On multivariate analysis, the period of transplantation remained a significant predictor for OS (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.54 to 0.94; P = .02), progression-free survival (PFS) (HR, 0.70; 95% CI, 0.52 to 0.94; P = .02), and TRM (HR, 0.57; 95% CI, 0.39 to 0.82; P = .002). In subgroup analysis, these differences were observed mainly in patients with grade IV acute GVHD. The outcomes of patients who develop overall grade III or IV acute GVHD after allogeneic HSCT has improved over time, with lower TRM and improved OS. This improvement in outcomes was seen primarily in patients with grade IV acute GVHD.
Collapse
Affiliation(s)
- Areej El-Jawahri
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Shuli Li
- Division of Hematology-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph H Antin
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Thomas R Spitzer
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Philippe A Armand
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John Koreth
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sarah Nikiforow
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Karen K Ballen
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Vincent T Ho
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Edwin P Alyea
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Bimalangshu R Dey
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Steven L McAfee
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Brett E Glotzbecker
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert J Soiffer
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Corey S Cutler
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yi-Bin Chen
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| |
Collapse
|