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Dhakal B, Sharma S, Balcioglu M, Shchegrova S, Malhotra M, Zimmermann B, Billings PR, Harrington A, Sethi H, Aleshin A, Hari PN. Assessment of Molecular Residual Disease Using Circulating Tumor DNA to Identify Multiple Myeloma Patients at High Risk of Relapse. Front Oncol 2022; 12:786451. [PMID: 35186734 PMCID: PMC8848740 DOI: 10.3389/fonc.2022.786451] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 09/30/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Despite treatment with high-dose chemotherapy followed by autologous stem cell transplantation (AHCT), patients with multiple myeloma (MM) invariably relapse. Molecular residual disease (MRD)-negativity post-AHCT has emerged as an important prognostic marker predicting the duration of remission. Current techniques for MRD assessment involve bone marrow (BM) aspirate sampling, which is invasive, subject to sample variability and is limited by spatial heterogeneity. We compared the performance of a non-invasive, circulating tumor DNA (ctDNA)-based MRD assay with multiparameter flow cytometry (MFC) of marrow aspirate to predict relapse in AHCT recipients with MM. Methods MRD assessment using ctDNA was retrospectively analyzed on 80 plasma samples collected at different time points from 28 patients, post-AHCT. MFC was used to assess MRD from BM biopsy. Individual archived BM aspirate slides or formalin-fixed paraffin-embedded slides from the time of MM diagnosis and matched blood were used to assess MRD at 3 months, post-AHCT, using a personalized, tumor-informed ctDNA assay. Results ctDNA was detectable in 70.8% (17/24) of pre-AHCT patients and 53.6% (15/28) of post-AHCT patients (3-month time point). Of the 15 post-AHCT ctDNA-positive patients, 14 relapsed on follow-up. The median PFS for ctDNA-positive patients was 31 months, and that for ctDNA-negative patients was 84 months (HR: 5.6; 95%CI: 1.8-17;p=0.0003). No significant difference in PFS was observed in patients stratified by MFC-based MRD status (HR 1.2; 95%CI: 0.3-3.4;p=0.73). The positive predictive value for ctDNA was also significantly higher than MFC (93.3% vs. 68.4%). Conclusions This study demonstrates tumor-informed ctDNA analysis is strongly predictive of MM relapse.
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Affiliation(s)
- Binod Dhakal
- Division of Blood and Marrow Transplant (BMT) & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | | | | | | | | | | | - Alexandra Harrington
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | | | - Parameswaran N Hari
- Division of Blood and Marrow Transplant (BMT) & Cellular Therapy, Medical College of Wisconsin, Milwaukee, WI, United States
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Munshi PN, Vesole DH, St Martin A, Davila O, Kumar S, Qazilbash M, Shah N, Hari PN, D'Souza A. Outcomes of upfront autologous hematopoietic cell transplantation in patients with multiple myeloma who are 75 years old or older. Cancer 2021; 127:4233-4239. [PMID: 34374445 DOI: 10.1002/cncr.33831] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Consolidative autologous hematopoietic stem cell transplantation (AHCT) is commonly used for patients with multiple myeloma (MM). We studied AHCT use and outcomes in patients with MM ≥75 years old. METHODS Patients with MM ≥75 years old receiving AHCT between 2013 and 2017 in the United States were identified using the Center for International Blood and Marrow Transplant Research database. Relapse and/or progression (REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models. Covariates used were age, sex, Karnofsky performance score (KPS), HCT-comorbidity index (HCT-CI), International Staging System and/or Durie-Salmon stage, high-risk cytogenetics, melphalan dose, and disease status at and 1 year after transplant. AHCT utilization rate using the Surveillance, Epidemiology, and End Results database was used to estimate specific incidence among ≥75 years old by race and gender. RESULTS Of 360 patients, 63% were male, 84% were White, 56% had KPS <90, and 57% had HCT-CI ≥3. The 100-day transplant-related mortality was 1% (0%-2%) with a 2-year REL rate of 27% (95% confidence interval [CI], 22%-33%), PFS of 66% (95% CI, 60%-72%), and OS of 83% (95% CI, 78%-87%). On multivariate analysis, only high-risk cytogenetics was associated with REL risk and decreased PFS. In White males, transplant utilization rate was 5.2%-5.8% compared to 3.5%-4.0% in African American males (P = .02). There was 3.37-3.79% transplant utilization in White females compared to 1.88-2.12% in African American females (P < .01). CONCLUSIONS The use of AHCT was associated with excellent 2-year outcomes in this selected MM population ≥75 years old. Transplant utilization for patients ≥75 years old remains low with significant racial and gender disparities.
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Affiliation(s)
| | - David H Vesole
- Georgetown University Hospital, Washington, DC.,John Theurer Cancer Center at Hackensack UMC, Hackensack, New Jersey
| | - Andrew St Martin
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Omar Davila
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Nina Shah
- Division of Hematology-Oncology, University of California-San Francisco, San Francisco, California
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Chhabra S, Visotcky A, Pasquini MC, Zhu F, Tang X, Zhang MJ, Thompson R, Abedin S, D'Souza A, Dhakal B, Drobyski WR, Fenske TS, Jerkins JH, Rizzo JD, Runaas L, Saber W, Shah NN, Shaw BE, Horowitz MM, Hari PN, Hamadani M. Corrigendum to ‘Ixazomib for chronic Graft-Versus-Host Disease prophylaxis following allogeneic hematopoietic cell transplantation’ [Biology of Blood and Marrow Transplantation 26/10 (2020) 1876-1885]. Transplant Cell Ther 2021; 28:717. [DOI: 10.1016/j.jtct.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chhabra S, Visotcky A, Pasquini MC, Zhu F, Tang X, Zhang MJ, Thompson R, Abedin S, D'Souza A, Dhakal B, Drobyski WR, Fenske TS, Jerkins JH, Douglas Rizzo J, Runaas L, Saber W, Shah NN, Shaw BE, Horowitz MM, Hari PN, Hamadani M. Ixazomib for Chronic Graft-versus-Host Disease Prophylaxis following Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2020; 26:1876-1885. [PMID: 32653622 PMCID: PMC7571859 DOI: 10.1016/j.bbmt.2020.07.005] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/12/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Abstract
Chronic graft-versus-host disease (cGVHD) is major cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (HCT). Ixazomib is an oral, second-generation, proteasome inhibitor that has been shown in preclinical models to prevent GVHD. We conducted a phase I/II trial in 57 patients to evaluate the safety and efficacy of ixazomib administration for cGVHD prophylaxis in patients undergoing allogeneic HCT. Oral ixazomib was administered on a weekly basis for a total of 4 doses, beginning days +60 through +90, to recipients of matched related donor (MRD, n = 25) or matched unrelated donor (MUD, n = 26) allogeneic HCT in phase II portion of the study, once the recommended phase II dose of 4 mg was identified in phase I (n = 6). All patients received peripheral blood graft and standard GVHD prophylaxis of tacrolimus and methotrexate. Ixazomib administration was safe and well tolerated, with thrombocytopenia, leukopenia, gastrointestinal complaints, and fatigue the most common adverse events (>10%). In phase II (n = 51), the cumulative incidence of cGVHD at 1 year was 36% (95% confidence interval [CI], 19% to 54%) in the MRD cohort and 39% (95% CI, 21% to 56%) in the MUD cohort. One-year cumulative incidence of nonrelapse mortality (NRM) and relapse was 0% and 20% (95% CI, 8% to 36%) in the MRD cohort, respectively. In the MUD cohort, the respective NRM and relapse rates were 4% (0% to 16%) and 34% (17% to 52%). The outcomes on the study were compared post hoc with contemporaneous matched Center for International Blood and Marrow Transplant Research (CIBMTR) controls. This post hoc analysis showed no significant improvement in cGVHD rates in both the MRD (hazard ratio [HR] = 0.85, P = .64) or MUD cohorts (HR = 0.68, P = .26) on the study compared with CIBMTR controls. B cell activating factor plasma levels were significantly higher after ixazomib dosing in those who remained cGVHD free compared with those developed cGVHD. This study shows that the novel strategy of short-course oral ixazomib following allogeneic HCT is safe but did not demonstrate significant improvement in cGVHD incidence in recipients of MRD and MUD transplantation compared with matched CIBMTR controls. This study is registered at www.clinicaltrials.gov as NCT02250300.
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Affiliation(s)
- Saurabh Chhabra
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Alexis Visotcky
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo C Pasquini
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Fenlu Zhu
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Xiaoying Tang
- Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin; Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin; Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert Thompson
- Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Sameem Abedin
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Binod Dhakal
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William R Drobyski
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James H Jerkins
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - J Douglas Rizzo
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Lyndsey Runaas
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wael Saber
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Nirav N Shah
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen E Shaw
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Mary M Horowitz
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Parameswaran N Hari
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin.
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5
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Munshi PN, Vesole D, Jurczyszyn A, Zaucha JM, St Martin A, Davila O, Agrawal V, Badawy SM, Battiwalla M, Chhabra S, Copelan E, Kharfan-Dabaja MA, Farhadfar N, Ganguly S, Hashmi S, Krem MM, Lazarus HM, Malek E, Meehan K, Murthy HS, Nishihori T, Olin RL, Olsson RF, Schriber J, Seo S, Shah G, Solh M, Tay J, Kumar S, Qazilbash MH, Shah N, Hari PN, D'Souza A. Age no bar: A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma. Cancer 2020; 126:5077-5087. [PMID: 32965680 DOI: 10.1002/cncr.33171] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 04/20/2020] [Revised: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults. METHODS The authors investigated the outcomes of AHCT in patients with MM who were aged ≥70 years. The Center for International Blood and Marrow Transplant Research (CIBMTR) database registered 15,999 patients with MM in the United States within 12 months of diagnosis during 2013 through 2017; a total of 2092 patients were aged ≥70 years. Nonrecurrence mortality (NRM), disease recurrence and/or progression (relapse; REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models with age at transplantation as the main effect. Because of the large sample size, a P value <.01 was considered to be statistically significant a priori. RESULTS An increase in AHCT was noted in 2017 (28%) compared with 2013 (15%) among patients aged ≥70 years. Although approximately 82% of patients received melphalan (Mel) at a dose of 200 mg/m2 overall, 58% of the patients aged ≥70 years received Mel at a dose of 140 mg/m2 . On multivariate analysis, patients aged ≥70 years demonstrated no difference with regard to NRM (hazard ratio [HR] 1.3; 99% confidence interval [99% CI], 1-1.7 [P = .06]), REL (HR, 1.03; 99% CI, 0.9-1.1 [P = 0.6]), PFS (HR, 1.06; 99% CI, 1-1.2 [P = 0.2]), and OS (HR, 1.2; 99% CI, 1-1.4 [P = .02]) compared with the reference group (those aged 60-69 years). In patients aged ≥70 years, Mel administered at a dose of 140 mg/m2 was found to be associated with worse outcomes compared with Mel administered at a dose of 200 mg/m2 , including day 100 NRM (1% [95% CI, 1%-2%] vs 0% [95% CI, 0%-1%]; P = .003]), 2-year PFS (64% [95% CI, 60%-67%] vs 69% [95% CI, 66%-73%]; P = .003), and 2-year OS (85% [95% CI, 82%-87%] vs 89% [95% CI, 86%-91%]; P = .01]), likely representing frailty. CONCLUSIONS The results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups.
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Affiliation(s)
| | - David Vesole
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Artur Jurczyszyn
- Medicini Department of Hematology, Jagiellonian University Medical College, Krakow, Poland.,Krakow Branch Polish Society of Haematology and Blood Transfusion, Krakow, Poland
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Andrew St Martin
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Omar Davila
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vaibhav Agrawal
- Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Saurabh Chhabra
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.,Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.,Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maxwell M Krem
- Markey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Ehsan Malek
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kenneth Meehan
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Rebecca L Olin
- University of California at San Francisco, San Francisco, California
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Jeffrey Schriber
- Cancer Transplant Institute, Virginia G. Piper Cancer Center, Scottsdale, Arizona.,Arizona Oncology, Scottsdale, Arizona
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Gunjan Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Jason Tay
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Shaji Kumar
- Department of Hematology, Mayo Clinic Rochester, Rochester, Minnesota
| | | | - Nina Shah
- University of California at San Francisco, San Francisco, California
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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6
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Chhabra S, Thapa B, Szabo A, Konings S, D'Souza A, Dhakal B, Jerkins JH, Pasquini MC, Johnson BD, Hari PN, Hamadani M. Utilization and Cost Implications of Hematopoietic Progenitor Cells Stored for a Future Salvage Autologous Transplantation or Stem Cell Boost in Myeloma Patients. Biol Blood Marrow Transplant 2020; 26:2011-2017. [PMID: 32717431 DOI: 10.1016/j.bbmt.2020.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/05/2020] [Revised: 07/04/2020] [Accepted: 07/15/2020] [Indexed: 01/24/2023]
Abstract
Autologous hematopoietic cell transplantation (autoHCT) is a standard initial treatment for multiple myeloma (MM). Consensus guidelines recommend collecting sufficient hematopoietic progenitor cells (HPCs) for 2 autoHCTs in all eligible patients. Despite a lack of published data on the utilization of HPCs stored for future use, it is common practice across transplantation programs to collect enough HPCs for 2 autoHCTs in MM patients. In this single-center retrospective study, we analyzed the utilization of HPCs collected and stored at the time of first autoHCT in patients with MM, along with the cost implications of HPC collection targets sufficient for 2 transplantations. In a cohort of 400 patients (median age, 63 years; range, 22 to 79 years), after a median follow-up of 50.4 months, 197 patients had relapsed and 36 had received HPC infusion as salvage autoHCT (n = 29) and/or HPC boost (n = 8). In this cohort, a median CD34+ cell dose of 4.3 × 106/kg (range, 1.1 to 12.94.3 × 106/kg) was used for first autoHCT, and a median of 4.4 × 106/kg (range, 1.0 to 20.2× 106/kg) CD34+ cells were stored for future use. At 6 years after the first autoHCT, the estimated cumulative incidence of salvage autoHCT was 12.0% without HPC boost and 13.9% with HPC boost. HPC utilization was significantly higher in the 60- to 64-year age group, whereas no patients who were age ≥70 years at the time of first autoHCT received salvage autoHCT. Using the CD34+ cell dose infused during the first autoHCT as the cutoff for individual patients, the estimated mean additional cost of HPC collection intended for subsequent use (over and above the HPCs used for first autoHCT) was $10,795 ($4.32 million for the entire cohort), an estimated 14% of which (ie, $583,600) was actually used up in salvage autoHCT by 6 years from first autoHCT. In conclusion, our results suggest the need for reappraisal of HPC collection targets for salvage autoHCT and argue against HPC collection and storage for salvage autoHCT in patients age ≥70 years at the time of first autoHCT.
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Affiliation(s)
- Saurabh Chhabra
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin.
| | - Bicky Thapa
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Steve Konings
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Binod Dhakal
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James H Jerkins
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo C Pasquini
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Bryon D Johnson
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran N Hari
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant & Cellular Therapy Program, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee Campus, Milwaukee, Wisconsin
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7
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Richardson PG, Nagler A, Ben‐Yehuda D, Badros A, Hari PN, Hajek R, Spicka I, Kaya H, LeBlanc R, Yoon S, Kim K, Martinez‐Lopez J, Mittelman M, Shpilberg O, Blake P, Hideshima T, Colson K, Laubach JP, Ghobrial IM, Leiba M, Gatt ME, Sportelli P, Chen M, Anderson KC. Randomized, placebo‐controlled, phase 3 study of perifosine combined with bortezomib and dexamethasone in patients with relapsed, refractory multiple myeloma previously treated with bortezomib. eJHaem 2020; 1:94-102. [PMID: 35847734 PMCID: PMC9175725 DOI: 10.1002/jha2.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/16/2022]
Abstract
Perifosine, an investigational, oral, synthetic alkylphospholipid, inhibits signal transduction pathways of relevance in multiple myeloma (MM) including PI3K/Akt. Perifosine demonstrated anti‐MM activity in preclinical studies and encouraging early‐phase clinical activity in combination with bortezomib. A randomized, double‐blind, placebo‐controlled phase 3 study was conducted to evaluate addition of perifosine to bortezomib‐dexamethasone in MM patients with one to four prior therapies who had relapsed following previous bortezomib‐based therapy. The primary endpoint was progression‐free survival (PFS). The study was discontinued at planned interim analysis, with 135 patients enrolled. Median PFS was 22.7 weeks (95% confidence interval 16·0–45·4) in the perifosine arm and 39.0 weeks (18.3–50.1) in the placebo arm (hazard ratio 1.269 [0.817–1.969]; P = .287); overall response rates were 20% and 27%, respectively. Conversely, median overall survival (OS) was 141.9 weeks and 83.3 weeks (hazard ratio 0.734 [0.380–1.419]; P = .356). Overall, 61% and 55% of patients in the perifosine and placebo arms reported grade 3/4 adverse events, including thrombocytopenia (26% vs 14%), anemia (7% vs 8%), hyponatremia (6% vs 8%), and pneumonia (9% vs 3%). These findings demonstrate no PFS benefit from the addition of perifosine to bortezomib‐dexamethasone in this study of relapsed/refractory MM, but comparable safety and OS.
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Affiliation(s)
- Paul G. Richardson
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
| | | | | | - Ashraf Badros
- Greenebaum Comprehensive Cancer Center University of Maryland Baltimore Maryland USA
| | - Parameswaran N. Hari
- Department of Hematology/Oncology Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Roman Hajek
- Department of Hematooncology University Hospital, Ostrava, and Faculty of Medicine University of Ostrava Ostrava Czech Republic
| | - Ivan Spicka
- First Department of Medicine, Department of Hematology First Faculty of Medicine Charles University and General Hospital in Prague Prague Czech Republic
| | - Hakan Kaya
- Cancer Care Northwest Spokane Washington USA
| | - Richard LeBlanc
- CIUSSS de l'est de l’île de Montréal University of Montreal Montreal Canada
| | - Sung‐Soo Yoon
- Department of Internal Medicine Seoul National University College of Medicine Seoul South Korea
| | - Kihyun Kim
- Sungkyunkwan University School of Medicine Samsung Medical Center Seoul South Korea
| | | | | | - Ofer Shpilberg
- Institute of Hematology Assuta Medical Centers Tel Aviv and Ariel University Ariel Israel
| | | | - Teru Hideshima
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Kathleen Colson
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Jacob P. Laubach
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Irene M. Ghobrial
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Merav Leiba
- Assuta Ashdod University Hospital Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheba Israel
| | | | | | | | - Kenneth C. Anderson
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
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Chhabra S, Abedin S, Graham MB, Ferrer Marrero TM, Hari PN, Shaw BE. Letter to the Editor Regarding "Diagnostic Considerations for COVID-19 in Recipients of Allogeneic Hematopoietic Cell Transplantation". Biol Blood Marrow Transplant 2020; 26:e241-e242. [PMID: 32589922 PMCID: PMC7309826 DOI: 10.1016/j.bbmt.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Sameem Abedin
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Beth Graham
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tirsa M Ferrer Marrero
- Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran N Hari
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen E Shaw
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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9
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Abid MB, Hamadani M, Szabo A, Hari PN, Graham MB, Frank MO, Collier WS, Abedin S, Jerkins JH, Pasquini MC, Runaas L, Shah NN, Chhabra S. Severity of Cytokine Release Syndrome and Its Association with Infections after T Cell-Replete Haploidentical Related Donor Transplantation. Biol Blood Marrow Transplant 2020; 26:1670-1678. [PMID: 32562858 DOI: 10.1016/j.bbmt.2020.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/08/2020] [Revised: 06/06/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
Abstract
An increased risk of infections has been described after T cell-replete haploidentical cell transplantation (haploHCT). Cytokine release syndrome (CRS) after haploHCT is a known phenomenon, but the impact of CRS severity on the risk of infections remains unexplored. We retrospectively evaluated 78 consecutive adult haploHCT recipients from 2012 to 2018 for the development of CRS (graded based on the criteria of Lee et al) and examined the incidence and mortality due to infections in correlation with CRS severity. In our study cohort, which was stratified into 3 groups by severity of CRS, 80% of the patients developed infections within 180 days of HCT. Significantly higher proportions of patients with CRS grade 2 (89%) and grade ≥3 (90%) than patients with CRS grade 0-1 (68%) had at least 1 infection in the first 100 days (P = .04). Bloodstream infections (BSIs) were seen more frequently in patients with CRS grade 2 and grade ≥3 in the first 6 months. Multivariable analysis for time to infection showed that CRS grade ≥3 was independently associated with an elevated risk of any infection compared with CRS grade 0-1 (hazard ratio [HR], 3.05; P = .007). CRS grade ≥3 was also associated with a higher hazard of viral (HR, 3.42; P = .04) and bacterial infections (HR, 2.83; P = .03) compared with CRS grade 0-1. After adjusting for time to neutrophil engraftment as a time-dependent covariate, CRS grade ≥3 still had a significant effect on viral infections (HR, 2.49; P = .03), but not on bacterial infections (HR, 1.32; P = .57). CRS grade was also a significant predictor for infection density (overall, bacterial, and viral). The incidence of infection-related mortality by day +100 was higher in patients with severe CRS. Severe CRS developing after post-transplantation cyclophosphamide-based haploHCT is independently associated with viral infections and an increased risk of bacterial infections, likely through delayed neutrophil engraftment.
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Affiliation(s)
- Muhammad Bilal Abid
- Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin; BMT & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center of International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran N Hari
- BMT & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Beth Graham
- Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael O Frank
- Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William S Collier
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sameem Abedin
- BMT & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James H Jerkins
- BMT & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo C Pasquini
- BMT & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center of International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lyndsey Runaas
- BMT & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nirav N Shah
- BMT & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- BMT & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center of International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Nikolaenko L, Chhabra S, Biran N, Chowdhury A, Hari PN, Krishnan A, Richter J. Graft-Versus-Host Disease in Multiple Myeloma Patients Treated With Daratumumab After Allogeneic Transplantation. Clinical Lymphoma Myeloma and Leukemia 2020; 20:407-414. [DOI: 10.1016/j.clml.2020.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/11/2020] [Accepted: 01/16/2020] [Indexed: 01/05/2023]
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D'Souza A, Szabo A, Flynn KE, Dhakal B, Chhabra S, Pasquini MC, Weihrauch D, Hari PN. Adjuvant doxycycline to enhance anti-amyloid effects: Results from the dual phase 2 trial. EClinicalMedicine 2020; 23:100361. [PMID: 32529175 PMCID: PMC7280748 DOI: 10.1016/j.eclinm.2020.100361] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although, doxycycline use is associated with improved outcomes in amyloidosis in retrospective studies, evidence from clinical trials is limited. METHODS This phase 2 trial of doxycycline (clinicaltrials.gov: NCT02207556) in newly diagnosed light chain (AL) amyloidosis enrolled 25 patients with systemic AL amyloidosis on treatment with doxycycline for 1 year along with chemotherapy. Outcomes of interest included mortality, organ response, and hematologic response rates at 1 year. FINDINGS The median age was 62 years, 64% were male, and 68% had the AL lambda subtype. Patients had Mayo 2012 stage 3 in 24% and stage 4 in 28%. Cardiac involvement was present in 60% of patients, renal involvement in 72%, and 60% patients had 3 or more organs involved. Target organ was cardiac in 14(56%), renal in 7(28%), hepatic in 1(4%) and soft tissue in 3(12%). At 1 year, mortality was 20% (95% confidence interval, 8.9-41.6%) and organ response was 36% (18-57%). Hematologic response in 1-year survivors was 100%, including 30% complete and 55% very good partial response. Autologous hematopoietic cell transplant was performed in 60%; among transplanted patients, day-100 transplant-related mortality was 0. Doxycycline use was safe and not attributed to any grade 2 or higher toxicity. INTERPRETATION In addition to a low 1-year mortality, doxycycline use was safe and associated with high transplant utilization rate. We thus contend that doxycycline should be studied in a placebo-controlled study in newly diagnosed AL patients in the first year, particularly among patients with advanced disease and cardiac involvement.
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Affiliation(s)
- Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, United States
- Corresponding author.
| | - Aniko Szabo
- Division of Biostatistics, Institute of Health and Safety, United States
| | - Kathryn E. Flynn
- Division of Hematology/Oncology, Department of Medicine, United States
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, United States
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, United States
| | | | - Dorothee Weihrauch
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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12
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Badar T, Astle J, Kakar IK, Zellner K, Hari PN, Hamadani M. Clinical activity of ibrutinib in classical Hodgkin lymphoma relapsing after allogeneic stem cell transplantation is independent of tumor BTK expression. Br J Haematol 2020; 190:e98-e101. [PMID: 32415780 DOI: 10.1111/bjh.16738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/21/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Talha Badar
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Astle
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Katie Zellner
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Parameswaran N Hari
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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13
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Dhakal B, Narra RK, Giri S, Szabo A, Smunt TL, Ghose S, Pathak LK, Aryal M, Hamadani M, Chhabra S, Janz S, D'Souza A, Hari PN. Association of adverse events and associated cost with efficacy for approved relapsed and/or refractory multiple myeloma regimens: A Bayesian network meta-analysis of phase 3 randomized controlled trials. Cancer 2020; 126:2791-2801. [PMID: 32154922 DOI: 10.1002/cncr.32831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/18/2019] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Several new treatment options have been approved for relapsed and/or refractory multiple myeloma (RRMM). In this systematic review, associations of the efficacy of each approved regimen with adverse events (AEs) and the total cost per cycle were compared with a Bayesian network meta-analysis (NMA) of phase 3 randomized controlled trials (RCTs). METHODS Scopus, Cochrane, PubMed Publisher, and Web of Science were searched from January 1999 to July 2018 for phase 3 RCTs of regimens (approved by the US Food and Drug Administration) used in RRMM. The relative ranking of agents was assessed with surface under the cumulative ranking (SUCRA) probabilities. The primary efficacy, safety, and cost outcomes were progression-free survival with the regimen, grade 3 to 4 AEs, and the total cost per cycle (regimen cost plus average cost of managing AEs). RESULTS Fifteen studies including 7718 patients and evaluating 14 different regimens were identified. Daratumumab, lenalidomide, and dexamethasone were ranked highest for reducing progression (hazard ratio, 0.13; 95% credible interval, 0.09-0.19; SUCRA, 1) but carried the highest probability of total cost per cycle ($41,420; 95% Credible Interval [CrCl], $58,665-$78,041; SUCRA, 0.02). Panobinostat, bortezomib, and dexamethasone were the least effective and least safe (SUCRA, 0.24), whereas bortezomib, thalidomide, and dexamethasone emerged as least effective with the highest total cost per cycle (SUCRA, 0.33). Carfilzomib and dexamethasone emerged as the winner when this regimen was considered in terms of efficacy and safety (SUCRA, 0.61) and efficacy and total cost per cycle (SUCRA, 0.60). CONCLUSIONS The results of this NMA can provide additional guidance for the decision-making process when one is choosing the most appropriate regimen for RRMM.
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Affiliation(s)
- Binod Dhakal
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ravi K Narra
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Smith Giri
- Division of Hematology/Oncology, Yale University, New Haven, Connecticut
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy L Smunt
- Sheldon B. Lubar School of Business, University of Wisconsin Milwaukee, Milwaukee, Wisconsin
| | - Sanjoy Ghose
- Sheldon B. Lubar School of Business, University of Wisconsin Milwaukee, Milwaukee, Wisconsin
| | | | - Madan Aryal
- Division of Hematology/Oncology, Roswell Park, Buffalo, New York
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Siegfried Janz
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran N Hari
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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14
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Chhabra S, Szabo A, Glisch C, George G, Narra RK, Harrington A, Jerkins JH, D'Souza A, Dhakal B, Pasquini MC, Hamadani M, Hari PN. Relapse after Allogeneic Hematopoietic Cell Transplantation for Multiple Myeloma: Survival Outcomes and Factors Influencing Them. Biol Blood Marrow Transplant 2020; 26:1288-1297. [PMID: 32135202 DOI: 10.1016/j.bbmt.2020.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/03/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 02/05/2023]
Abstract
Many patients with multiple myeloma (MM) eventually relapse even after allogeneic hematopoietic cell transplantation (alloHCT) for curative intent. Over the past decade, outcomes for patients with MM have improved significantly with the availability of new therapies, including next-generation proteasome inhibitors, immunomodulatory agents, and, more recently, monoclonal antibodies. Although several published studies have evaluated the outcomes of alloHCT for MM, the data on survival outcomes in patients with MM experiencing disease relapse following alloHCT are limited. In addition, the predictors for postrelapse survival in these patients are not known. In this study, we examined the outcomes of a single-center cohort of 60 patients with MM who experienced relapse or progression after alloHCT. In addition, we evaluated the use of salvage regimens for treatment of relapsed MM and analyzed the predictors for improved postrelapse survival. After a median follow-up of 2.2 years from the time of relapse, the median duration of postrelapse survival was 1.8 years (95% confidence interval [CI], 1.2 to 5.0 years). Patients received a median of 3 lines of therapy (range, 0 to 10) for treatment of MM beyond the post-alloHCT relapse/progression. Multivariate analysis identified cytogenetic risk (standard risk versus high risk; hazard ratio [HR], .34; P = .01), time to relapse after alloHCT (>12 months versus ≤12 months: HR, .41; P = .04), and occurrence of acute graft-versus-host disease (GVHD) before relapse (GVHD versus no GVHD: HR, 2.89; P = .01) significantly affected postrelapse survival. These data illustrate that long-term myeloma control and survival is attainable in those relapsing/progressing after alloHCT and suggest that the synergism between novel therapies and the allogeneic immune platform is the key to improved survival in this high-risk patient population.
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Affiliation(s)
- Saurabh Chhabra
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute of Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Chad Glisch
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gemlyn George
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ravi K Narra
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alexandra Harrington
- Division of Hematopathology, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James H Jerkins
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Binod Dhakal
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo C Pasquini
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Parameswaran N Hari
- BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
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15
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Chhabra S, Narra RK, Wu R, Szabo A, George G, Michaelis LC, D'Souza A, Dhakal B, Drobyski WR, Fenske TS, Jerkins JH, Pasquini MC, Rizzo RD, Saber W, Shah NN, Shaw BE, Hamadani M, Hari PN. Fludarabine/Busulfan Conditioning-Based Allogeneic Hematopoietic Cell Transplantation for Myelofibrosis: Role of Ruxolitinib in Improving Survival Outcomes. Biol Blood Marrow Transplant 2020; 26:893-901. [PMID: 31982543 DOI: 10.1016/j.bbmt.2020.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/30/2019] [Revised: 01/11/2020] [Accepted: 01/17/2020] [Indexed: 12/29/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is the only curative treatment modality for primary myelofibrosis (MF) and related myeloproliferative neoplasms. Older age at diagnosis and age-related comorbidities make most patients ineligible for allo-HCT, given concerns for nonrelapse mortality (NRM). Here we report the outcomes of 37 consecutive recipients of allo-HCT for MF performed at a single center between 2009 and 2018 with a standardized institutional protocol. Most patients received ruxolitinib before HCT (n = 32), and those with splenomegaly >22 cm received pretransplantation splenic irradiation. The median age at HCT was 60 years (range, 40 to 74 years), and 68% of the cohort carried a JAK2 driver mutation. All patients received fludarabine/busulfan-based conditioning; 22 patients (59%) received a reduced-intensity conditioning regimen. All patients received peripheral blood grafts, from a matched sibling donor in 16 patients (43%), an unrelated donor in 20 patients, and a haploidentical-related donor in 1 patient. Sixty-one percent had a Hematopoietic Cell Transplantation Comorbidity Index ≥3, 40% had a Karnofsky Performance Status score <90, and 24% had a high-risk DIPSS Plus score. With a median follow-up of 40.2 months (range, 16.9 to 115 months), the 3-year overall survival and relapse-free survival were 81.1% (95% confidence interval [CI], 64.4% to 90.5%) and 78.4% (95% CI, 61.4% to 88.5%), respectively. Only 2 patients relapsed/progressed after transplant. NRM at 2 years was 16.2% (95% CI, 6.5% to 29.9%). All patients engrafted. Sixteen patients were treated with ruxolitinib post-transplantation for graft-versus-host disease, graft rejection/relapse, or persistent MF. These results suggest that pretransplantation ruxolitinib, fludarabine/busulfan-based conditioning, and splenic management are keys to improved transplantation outcomes in patients undergoing allo-HCT for MF.
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Affiliation(s)
- Saurabh Chhabra
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Ravi K Narra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ruizhe Wu
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gemlyn George
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura C Michaelis
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Binod Dhakal
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William R Drobyski
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy S Fenske
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James H Jerkins
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo C Pasquini
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - R Douglas Rizzo
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wael Saber
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nirav N Shah
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen E Shaw
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran N Hari
- Blood and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Chhabra S, Jerkins JH, Conto JE, Zellner K, Shah NN, Hari PN, Hamadani M. Lifitegrast ophthalmic solution for treatment of ocular chronic graft-versus-host disease. Leuk Lymphoma 2019; 61:869-874. [PMID: 31762357 DOI: 10.1080/10428194.2019.1695049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ocular chronic graft-versus-host disease (oGVHD) is a relatively common complication that occurs following allogeneic hematopoietic cell transplantation. Keratoconjunctivitis sicca (KCS) is the most common manifestation of oGVHD. Lifitegrast is a lymphocyte function-associated antigen-1 antagonist approved to reduce inflammation and symptoms in patients with dry eye disease. We evaluated the efficacy and safety of lifitegrast (5% ophthalmic solution) in patients with ocular GVHD in a single-institution retrospective cohort study of eighteen allogeneic transplant recipients who received topical lifitegrast for oGVHD treatment. The outcome of interest was improvement in oGVHD severity score by National Institutes of Health (NIH) criteria. Lifitegrast was well-tolerated and no serious adverse events were observed. Lifitegrast significantly improved NIH severity scores in 8 (44%) patients. The findings of this study suggest lifitegrast is safe, well-tolerated and is an effective option for oGVHD manifesting as KCS. Prospective evaluation is warranted to confirm efficacy of lifitegrast in this population.HighlightsIn this single-institution retrospective cohort study of eighteen patients who received allogeneic transplant between 2013 and 2018, and received topical lifitegrast for treatment of ocular GVHD, the results demonstrate that lifitegrast eye drops were well-tolerated and led to improvement in symptoms of KCS in 8 (44%) patients.Lifitegrast has the potential to fulfill an unmet need in allogeneic transplant patients with ocular GVHD. Further prospective study is warranted for confirmation.
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Affiliation(s)
- Saurabh Chhabra
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James H Jerkins
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John E Conto
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katie Zellner
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nirav N Shah
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Parameswaran N Hari
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Abstract
Considerable progress has been made in cancer therapeutics recently with targeted strategies that are efficacious and less toxic. Immunotherapy and chimeric antigen receptor (CAR) T-cells are increasingly being evaluated in a variety of tumors in the relapsed/refractory as well as frontline disease settings, predominantly in hematologic malignancies (HM). Despite impressive outcomes in select patients, there remains significant heterogeneity in clinical response to CAR T-cells. The gut microbiome has emerged as one of the key host factors that could potentially be modulated to enhance responses to immunotherapy. Several recent human studies receiving immunotherapy showed a significantly superior response and survival in patients with the more diverse gut microbiome. Currently, it is unknown if gut microbiota modulates anti-tumor responses to CAR T-cells. Based on molecular and immunological understanding, we hypothesize that strategically manipulating gut microbiota may enhance responses to CAR T-cells. In this review, we further discuss resistance mechanisms to CAR T-cells in HM, potential approaches to overcome resistance by harnessing gut microbiota and other related novel strategies.
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Affiliation(s)
- Muhammad Bilal Abid
- 1Division of Infectious Diseases, Medical College of Wisconsin (MCW), Hub for Collaborative Medicine, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA.,2Division of Hematology/Oncology, Medical College of Wisconsin (MCW), Milwaukee, WI USA
| | - Nirav N Shah
- 2Division of Hematology/Oncology, Medical College of Wisconsin (MCW), Milwaukee, WI USA
| | - Theresa C Maatman
- 3Division of Internal Medicine, Medical College of Wisconsin (MCW), Milwaukee, WI USA
| | - Parameswaran N Hari
- 2Division of Hematology/Oncology, Medical College of Wisconsin (MCW), Milwaukee, WI USA
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18
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Dhakal B, Szabo A, Chhabra S, Hamadani M, D'Souza A, Usmani SZ, Sieracki R, Gyawali B, Jackson JL, Asimakopoulos F, Hari PN. Autologous Transplantation for Newly Diagnosed Multiple Myeloma in the Era of Novel Agent Induction: A Systematic Review and Meta-analysis. JAMA Oncol 2019; 4:343-350. [PMID: 29302684 DOI: 10.1001/jamaoncol.2017.4600] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance The role of high-dose therapy with melphalan followed by autologous stem cell transplant (HDT/ASCT) in patients with multiple myeloma continues to be debated in the context of novel agent induction. Objective To perform a systematic review, conventional meta-analysis, and network meta-analysis of all phase 3 randomized clinical trials (RCTs) evaluating the role of HDT/ASCT. Data Sources We performed a systematic literature search of Cochrane Central, MEDLINE, and Scopus from January 2000 through April 2017 and relevant annual meeting abstracts from January 2014 to December 2016. The following search terms were used: "myeloma" combined with "autologous," "transplant," "myeloablative," or "stem cell." Study Selection Phase 3 RCTs comparing HDT/ASCT with standard-dose therapy (SDT) using novel agents were assessed. Studies comparing single HDT/ASCT with bortezomib, lenalidomide, and dexamethasone consolidation and tandem transplantation were included for network meta-analysis. Data Extraction And Synthesis For the random effects meta-analysis, we used hazard ratios (HRs) and corresponding 95% CIs. Main Outcomes and Measures The primary outcome was progression-free survival (PFS). Overall survival (OS), complete response, and treatment-related mortality were secondary outcomes. Results A total of 4 RCTs (2421 patients) for conventional meta-analysis and 5 RCTs (3171 patients) for network meta-analysis were selected. The combined odds for complete response were 1.27 (95% CI, 0.97-1.65; P = .07) with HDT/ASCT when compared with SDT. The combined HR for PFS was 0.55 (95% CI, 0.41-0.74; P < .001) and 0.76 for OS (95% CI, 0.42-1.36; P = .20) in favor of HDT. Meta-regression showed that longer follow-up was associated with superior PFS (HR/mo, 0.98; 95% CI, 0.96-0.99; P = .03) and OS (HR/mo, 0.90; 95% CI, 0.84-0.96; P = .002). For PFS, tandem HDT/ASCT had the most favorable HR (0.49; 95% CI, 0.37-0.65) followed by single HDT/ASCT with bortezomib, lenalidomide, and dexamethasone (HR, 0.53; 95% CI, 0.37-0.76) and single HDT/ASCT alone (HR, 0.68; 95% CI, 0.53-0.87) compared with SDT. For OS, none of the HDT/ASCT-based approaches had a significant effect on survival. Treatment-related mortality with HDT/ASCT was minimal (<1%). Conclusions and Relevance The results of the conventional meta-analysis and network meta-analysis of all the phase 3 RCTs showed that HDT/ASCT was associated with superior PFS with minimal toxic effects compared with SDT. Both tandem HDT/ASCT and single HDT/ASCT with bortezomib, lenalidomide, and dexamethasone were superior to single HDT/ASCT alone and SDT for PFS, but OS was similar across the 4 approaches. Longer follow-up may better delineate any OS benefit; however, is likely to be affected by effective postrelapse therapy.
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Affiliation(s)
- Binod Dhakal
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee
| | - Anita D'Souza
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee
| | - Saad Z Usmani
- Plasma Cell Disorders Section, Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute, Charlotte, North Carolina
| | - Rita Sieracki
- MCW Libraries, Medical College of Wisconsin, Milwaukee
| | - Bishal Gyawali
- Department of Medical Oncology, University of Nagoya, Nagoya, Japan
| | - Jeffrey L Jackson
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee
| | - Fotis Asimakopoulos
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
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19
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Pulsipher MA, Logan BR, Kiefer DM, Chitphakdithai P, Riches ML, Rizzo JD, Anderlini P, Leitman OF, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Parameswaran V, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Confer DL, Shaw BE. Related peripheral blood stem cell donors experience more severe symptoms and less complete recovery at one year compared to unrelated donors. Haematologica 2019; 104:844-854. [PMID: 30381298 PMCID: PMC6442962 DOI: 10.3324/haematol.2018.200121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022] Open
Abstract
Unlike unrelated donor registries, transplant centers lack uniform approaches to related donor assessment and deferral. To test whether related donors are at increased risk for donation-related toxicities, we conducted a prospective observational trial of 11,942 related and unrelated donors aged 18-60 years. Bone marrow (BM) was collected at 37 transplant and 78 National Marrow Donor Program centers, and peripheral blood stem cells (PBSC) were collected at 42 transplant and 87 unrelated donor centers in North America. Possible presence of medical comorbidities was verified prior to donation, and standardized pain and toxicity measures were assessed pre-donation, peri-donation, and one year following. Multivariate analyses showed similar experiences for BM collection in related and unrelated donors; however, related stem cell donors had increased risk of moderate [odds ratios (ORs) 1.42; P<0.001] and severe (OR 8.91; P<0.001) pain and toxicities (OR 1.84; P<0.001) with collection. Related stem cell donors were at increased risk of persistent toxicities (OR 1.56; P=0.021) and non-recovery from pain (OR 1.42; P=0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors reporting grade ≥2 pain had significant decreases in Health-Related Quality of Life (HR-QoL) scores at one month and one year post donation (P=0.004). In conclusion, related PBSC donors with comorbidities are at increased risk for pain, toxicity, and non-recovery at one year after donation. Risk profiles described in this study should be used for donor education, planning studies to improve the related donor experience, and decisions regarding donor deferral. Registered at clinicaltrials.gov identifier:00948636.
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Affiliation(s)
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Marcie L Riches
- University of North Carolina Hospitals, Division of Hematology and Oncology Chapel Hill, NC
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - O'Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - John P Miller
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Aly Abdel-Mageed
- Department of Pediatrics and Human Development, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Ibrahim A Ahmed
- Department of Hematology and Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Indianapolis, IN
| | | | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, CA
| | | | | | | | | | | | | | - Christopher C Dvorak
- Division of Pediatric Blood and Marrow Transplantation, University of California San Francisco Benioff Children's Hospital, CA
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Division of Hematology/Oncology-Bone Marrow Pediatric Hematology & Medical Oncology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | - Kimberly A Kasow
- Pediatric Hematology Oncology Program, Bone Marrow and Stem Cell Transplantation Program, University of North Carolina Healthcare, Chapel Hill, NC
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, OH
| | - Jane L Liesveld
- Strong Memorial Hospital - University of Rochester Medical Center, NY
| | | | | | - Walter Longo
- University of Wisconsin Hospital and Clinics, Madison, WI
| | | | - John M McCarty
- Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program, Richmond, VA
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, FL
| | | | - Vinod K Prasad
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | | | | | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, NY
| | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, OK
| | | | - Shalini Shenoy
- Division of Hematology/Oncology, St. Louis Children's Hospital, MO
| | | | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL
| | | | - Madhuri Vusirikala
- Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Galen E Switzer
- Division of General Internal Medicine, University of Pittsburgh, PA, USA
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
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20
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Pulsipher MA, Logan BR, Chitphakdithai P, Kiefer DM, Riches ML, Rizzo JD, Anderlini P, Leitman SF, Varni JW, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Bunin NJ, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Shaw BE, Confer DL. Effect of Aging and Predonation Comorbidities on the Related Peripheral Blood Stem Cell Donor Experience: Report from the Related Donor Safety Study. Biol Blood Marrow Transplant 2019; 25:699-711. [PMID: 30423480 PMCID: PMC6453753 DOI: 10.1016/j.bbmt.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/27/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
The development of reduced-intensity approaches for allogeneic hematopoietic cell transplantation has resulted in growing numbers of older related donors (RDs) of peripheral blood stem cells (PBSCs). The effects of age on donation efficacy, toxicity, and long-term recovery in RDs are poorly understood. To address this we analyzed hematologic variables, pain, donation-related symptoms, and recovery in 1211 PBSC RDs aged 18 to 79 enrolled in the Related Donor Safety Study. RDs aged > 60 had a lower median CD34+ level before apheresis compared with younger RDs (age > 60, 59 × 106/L; age 41 to 60, 81 × 106/L; age 18 to 40, 121 × 106/L; P < .001). This resulted in older donors undergoing more apheresis procedures (49% versus 30% ≥ 2 collections, P < .001) and higher collection volumes (52% versus 32% > 24 L, P < .001), leading to high percentages of donors aged > 60 with postcollection thrombocytopenia <50 × 109/L (26% and 57% after 2 and 3days of collection, respectively). RDs aged 18 to 40 had a higher risk of grades 2 to 4 pain and symptoms pericollection, but donors over age 40 had more persistent pain at 1, 6, and 12 months (odds ratio [OR], 1.7; P = 0.02) and a higher rate of nonrecovery to predonation levels (OR, 1.7; P = .01). Donors reporting comorbidities increased significantly with age, and those with comorbidities that would have led to deferral by National Marrow Donor Program unrelated donor standards had an increased risk for persistent grades 2 to 4 pain (OR, 2.41; P < .001) and failure to recover to predonation baseline for other symptoms (OR, 2.34; P = .004). This information should be used in counseling RDs regarding risk and can assist in developing practice approaches aimed at improving the RD experience for high-risk individuals.
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Affiliation(s)
- Michael A Pulsipher
- Children's Hospital Los Angeles, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Los Angeles, California.
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Marcie L Riches
- University of North Carolina Hospitals, Division of Hematology and Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paolo Anderlini
- M.D. Anderson Cancer Center, Department of Stem Cell Transplantation and Cellular Therapy, Houston, Texas
| | - Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - James W Varni
- Texas A & M University, Department of Pediatrics, College Station, Texas
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - Ibrahim A Ahmed
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Indianapolis, Indiana
| | | | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, California
| | | | - Carolyn Bigelow
- University of Mississippi Medical Center, Jackson, Mississippi
| | | | | | - Nancy J Bunin
- Children's Hospital of Philadelphia, Division of Oncology, Philadelphia, Pennsylvania
| | - David C Delgado
- Indiana University Hospital/Riley Hospital for Children, Indianapolis, Indiana
| | - Katharine Duckworth
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Christopher C Dvorak
- University of California San Francisco Benioff Children's Hospital, Division of Pediatric Blood and Marrow Transplantation San Francisco, California
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Ann A Jakubowski
- Memorial Sloan Kettering Cancer Center-Adult, New York, New York
| | - Kimberly A Kasow
- University of North Carolina Healthcare, Chapel Hill, North Carolina
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jane L Liesveld
- Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | | | | | - Walter Longo
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | | | - John M McCarty
- Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program, Richmond, Virginia
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, Florida
| | | | | | - Witold B Rybka
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, OK
| | | | | | | | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | - Daniel J Weisdorf
- University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
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21
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Guru Murthy GS, Hari PN, Szabo A, Pasquini M, Narra R, Khan M, Abedin S, Chhabra S, Dhakal B, D'Souza A, Drobyski WR, Rizzo JD, Runaas L, Shah NN, Shaw B, Saber W, Fenske T, Hamadani M. Outcomes of Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Performed in the Inpatient versus Outpatient Setting. Biol Blood Marrow Transplant 2018; 25:827-833. [PMID: 30572109 DOI: 10.1016/j.bbmt.2018.12.069] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) with reduced-intensity conditioning (RIC) is commonly performed as an inpatient procedure. The feasibility and outcomes of RIC allo-HCT in the outpatient setting is not known. We performed a single-center retrospective cohort study of patients aged ≥ 18years with hematologic malignancies who underwent RIC allo-HCT either in the inpatient or outpatient setting. Donor types included HLA-matched sibling and well-matched unrelated donors. The objectives were to compare the survival, complications, charges, and incidences of relapse, nonrelapse mortality (NRM), and acute and chronic graft-versus-host disease (GVHD) between the 2 groups. Between 2014 and 2017, 151 eligible patients were included, with 116 undergoing RIC allo-HCT in the inpatient setting and 35 patients undergoing RIC allo-HCT in the outpatient setting. Baseline characteristics were comparable between the 2 groups except for a higher proportion of patients with myeloma in the outpatient cohort (inpatient 15.5% versus outpatient 37.1%). The cumulative incidence of grades II to IV acute GVHD (inpatient 25.2% versus outpatient 25.7%), grades III to IV acute GVHD (inpatient 10.4% versus outpatient 8.5%), chronic GVHD (inpatient 38.3% versus outpatient 51.6%), NRM at 1 year (inpatient 10.8% versus outpatient 3.2%), and relapse (inpatient 24.8% versus outpatient 33.2%) did not significantly differ between the 2 cohorts. One-year progression-free survival (inpatient 64.4% versus outpatient 63.6%, P = .39) and overall survival (inpatient 73.8% versus outpatient 82.8%, P = .93) were also not significantly different between the 2 groups. The proportion of patients who developed neutropenic fever (inpatient 25.8% versus outpatient 8.5%, P = .03) and mucositis (inpatient 50.8% versus outpatient 8.5%, P < .001) and who required total parenteral nutrition (inpatient 20.6% versus outpatient 5.7%, P = .04) were more frequent in the inpatient cohort. About 51.5% of the outpatient cohort never required hospital admission in the first 100days. Outpatient HCT resulted in significantly lower charges than inpatient HCT in the first 100days (median charges: inpatient $339,621 versus outpatient $247,334; P < .001). On multivariate analysis the site of the HCT (outpatient versus inpatient) was not a significant predictor of either overall or progression-free survival. Outpatient RIC allo-HCT is feasible and safe with daily outpatient evaluation and aggressive supportive care resulting in outcomes comparable with those who received the transplant in the inpatient setting.
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Affiliation(s)
- Guru Subramanian Guru Murthy
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran N Hari
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo Pasquini
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ravi Narra
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Muhammad Khan
- Division of Hospital Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sameem Abedin
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Binod Dhakal
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William R Drobyski
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - J Douglas Rizzo
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lyndsey Runaas
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nirav N Shah
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen Shaw
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wael Saber
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy Fenske
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Epperla N, Hamadani M, Ahn KW, He F, Kodali D, Kleman A, Hari PN, Pasquini M, Fenske TS, Craig MD, Kanate AS, Bachanova V. Survival of Lymphoma Patients Experiencing Relapse or Progression after an Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:983-988. [DOI: 10.1016/j.bbmt.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 01/13/2018] [Indexed: 01/23/2023]
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Raj RV, Hamadani M, Szabo A, Pasquini MC, Shah NN, Drobyski WR, Shaw BE, Saber W, Rizzo JD, Jerkins J, Fenske TS, D'Souza A, Dhakal B, Zhang C, Konings S, Hari PN, Chhabra S. Peripheral Blood Grafts for T Cell-Replete Haploidentical Transplantation Increase the Incidence and Severity of Cytokine Release Syndrome. Biol Blood Marrow Transplant 2018; 24:1664-1670. [PMID: 29680516 DOI: 10.1016/j.bbmt.2018.04.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 02/22/2018] [Accepted: 04/10/2018] [Indexed: 12/11/2022]
Abstract
T cell-replete post-transplant cyclophosphamide (PTCy)-based protocols have led to increasing use of haploidentical allogeneic hematopoietic cell transplantation (haploHCT). With this approach, bidirectional alloreactivity causing nonengraftment or severe graft-versus-host disease (GVHD) is no a longer major barrier to haploHCT. PTCy eliminates alloreactive lymphocytes but spares CD34+ stem cells and regulatory T lymphocytes, resulting in reliable hematopoietic recovery with relatively low incidence of GVHD. The immediate post-haploHCT course, usually before PTCy administration, is often complicated by cytokine release syndrome (CRS). The predictors of CRS and its effect on outcomes post-transplant have not been fully ascertained. We analyzed the outcomes of 66 patients who received haploHCT at our institution. Using published CRS criteria we identified 48 patients who developed CRS. In multivariate analysis peripheral blood grafts were significantly associated with grade ≥ 2 CRS, compared with bone marrow. Grade ≥ 2 CRS (compared with grade < 2) was not associated with differences in overall survival or nonrelapse mortality. Severe CRS was associated with a statistically nonsignificant trend toward higher incidences of grades III to IV acute GVHD, especially in the context of peripheral blood grafts. CRS is a common complication after T cell-replete peripheral blood haploHCT, but post-transplant survival outcomes may not be affected in those with severe CRS.
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Affiliation(s)
- Renju V Raj
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplantation Research, Milwaukee, Wisconsin.
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Equity, Milwaukee, Wisconsin
| | - Marcelo C Pasquini
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplantation Research, Milwaukee, Wisconsin
| | - Nirav N Shah
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William R Drobyski
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen E Shaw
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplantation Research, Milwaukee, Wisconsin
| | - Wael Saber
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplantation Research, Milwaukee, Wisconsin
| | - J Douglas Rizzo
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplantation Research, Milwaukee, Wisconsin
| | - James Jerkins
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy S Fenske
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplantation Research, Milwaukee, Wisconsin
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Chao Zhang
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Steve Konings
- Cell Processing Laboratory, Froedtert Hospital, Milwaukee, Wisconsin
| | - Parameswaran N Hari
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplantation Research, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Hamadani M, Hari PN. Indications and Outcomes of Allogeneic Hematopoietic Cell Transplantation for Hematologic Malignancies in Adults. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abdel-Wahab O, Abrahm JL, Adams S, Adewoye AH, Allen C, Ambinder RF, Anasetti C, Anastasi J, Anderson JA, Antin JH, Antony AC, Araten DJ, Armand P, Armstrong G, Armstrong SA, Arnold DM, Artz AS, Awan FT, Baglin TP, Benson DM, Benz EJ, Berliner N, Bhagat G, Bhardwaj N, Bhatia R, Bhatia S, Bhatt MD, Bhatt VR, Bitan M, Blinderman CD, Bollard CM, Braun BS, Brenner MK, Brittenham GM, Brodsky RA, Brown M, Broxmeyer HE, Brummel-Ziedins K, Brunner AM, Buadi FK, Burkhardt B, Burns M, Byrd JC, Caimi PF, Caligiuri MA, Canavan M, Cantor AB, Carcao M, Carroll MC, Carty SA, Castillo JJ, Chan AK, Chapin J, Chiu A, Chute JP, Clark DB, Coates TD, Cogle CR, Connell NT, Cooke E, Cooley S, Corradini P, Creager MA, Creger RJ, Cromwell C, Crowther MA, Cushing MM, Cutler C, Dang CV, Danial NN, Dave SS, DeCaprio JA, Dinauer MC, Dinner S, Diz-Küçükkaya R, Dodd RY, Donato ML, Dorshkind K, Dotti G, Dror Y, Dunleavy K, Dvorak CC, Ebert BL, Eck MJ, Eikelboom JW, Epperla N, Ershler WB, Evans WE, Faderl S, Ferrara JL, Filipovich AH, Fischer M, Fredenburgh JC, Friedman KD, Fuchs E, Fuller SJ, Gailani D, Galipeau J, Gallagher PG, Ganapathi KA, Gardner LB, Gee AP, Gerson SL, Gertz MA, Giardina PJ, Gibson CJ, Golan K, Golub TR, Gonzales MJ, Gotlib J, Gottschalk S, Grant MA, Graubert TA, Gregg XT, Gribben JG, Gross DM, Gruber TA, Guitart J, Gurbuxani S, Gur-Cohen S, Gutierrez A, Hamadani M, Hari PN, Hartwig JH, Hayman SR, Hayward CP, Hebbel RP, Heslop HE, Hillis C, Hillyer CD, Ho K, Hockenbery DM, Hoffman R, Hogg KE, Holtan SG, Horny HP, Hsu YMS, Hunter ZR, Huntington JA, Iancu-Rubin C, Iqbal A, Isenman DE, Israels SJ, Italiano JE, Jaffe ES, Jaffer IH, Jagannath S, Jäger U, Jain N, James P, Jeha S, Jordan MB, Josephson CD, Jung M, Kager L, Kambayashi T, Kanakry JA, Kantarjian HM, Kaplan J, Karafin MS, Karsan A, Kaufman RJ, Kaufman RM, Keller FG, Kelly KM, Kessler CM, Key NS, Keyzner A, Khandoga AG, Khanna-Gupta A, Khatib-Massalha E, Klein HG, Knoechel B, Kollet O, Konkle BA, Kontoyiannis DP, Koreth J, Koretzky GA, Kotecha D, Kremyanskaya M, Kumari A, Kuzel TM, Küppers R, Lacy MQ, Ladas E, Landier W, Lapid K, Lapidot T, Larson PJ, Levi M, Lewis RE, Liebman HA, Lillicrap D, Lim W, Lin JC, Lindblad R, Lip GY, Little JA, Lohr JG, López JA, Luscinskas FW, Maciejewski JP, Majhail NS, Manches O, Mandle RJ, Mann KG, Manno CS, Marcogliese AN, Mariani G, Marincola FM, Mascarenhas J, Massberg S, McEver RP, McGrath E, McKinney MS, Mehta RS, Mentzer WC, Merlini G, Merryman R, Michel M, Migliaccio AR, Miller JS, Mims MP, Mondoro TH, Moorehead P, Muniz LR, Munshi NC, Najfeld V, Nayak L, Nazy I, Neff AT, Ness PM, Notarangelo LD, O'Brien SH, O'Connor OA, O'Donnell M, Olson A, Orkin SH, Pai M, Pai SY, Paidas M, Panch SR, Pande RL, Papayannopoulou T, Parikh R, Petersdorf EW, Peterson SE, Pittaluga S, Ponce DM, Popolo L, Prchal JT, Pui CH, Puigserver P, Rak J, Ramos CA, Rand JH, Rand ML, Rao DS, Ravandi F, Rawlings DJ, Reddy P, Reding MT, Reiter A, Rice L, Riese MJ, Ritchey AK, Roberts DJ, Roman E, Rooney CM, Rosen ST, Rosenthal DS, Rossmann MP, Rot A, Rowley SD, Rubnitz JE, Rydz N, Salama ME, Sauk S, Saunthararajah Y, Savage W, Scadden D, Schaefer KG, Schiffman F, Schneidewend R, Schrier SL, Schuchman EH, Scullion BF, Selvaggi KJ, Senoo K, Shaheen M, Shaz BH, Shelburne SA, Shpall EJ, Shurin SB, Siegal D, Silberstein LE, Silberstein L, Silverstein RL, Sloan SR, Smith FO, Smith JW, Smith K, Steensma DP, Steinberg MH, Stock W, Storry JR, Stramer SL, Strauss RG, Stroncek DF, Taylor J, Thota S, Treon SP, Tulpule A, Valdes RF, Valent P, Vedantham S, Vercellotti GM, Verneris MR, Vichinsky EP, von Andrian UH, Vose JM, Wagner AJ, Wang E, Wang JH, Warkentin TE, Wasserstein MP, Webster A, Weisdorf DJ, Weitz JI, Westhoff CM, Wheeler AP, Widick P, Wiley JS, William BM, Williams DA, Wilson WH, Wolfe J, Wolgast LR, Wood D, Wu J, Yahalom J, Yee DL, Younes A, Young NS, Zeller MP. Contributors. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00168-2] [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: 10/18/2022] Open
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Kharfan-Dabaja MA, Al Malki MM, Deotare U, Raj RV, El-Jurdi N, Majhail N, Cherry MA, Bashir Q, Darrah J, Nishihori T, Sibai H, Hamadani M, de Lima M, Gerds AT, Selby G, Qazilbash MH, Forman SJ, Ayala E, Lipton JH, Hari PN, Muzzafar T, Zhang L, Olteanu H, Perkins J, Sokol L, Kumar A, Ahmed S. Haematopoietic cell transplantation for blastic plasmacytoid dendritic cell neoplasm: a North American multicentre collaborative study. Br J Haematol 2017; 179:781-789. [PMID: 28980314 DOI: 10.1111/bjh.14954] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 06/22/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is incurable with conventional therapies. Limited retrospective data have shown durable remissions after haematopoietic cell transplantation (HCT) [allogeneic (allo) or autologous (auto)]. We conducted a multicentre retrospective study in BPDCN patients treated with allo-HCT and auto-HCT at 8 centres in the United States and Canada. Primary endpoint was overall survival (OS). The population consisted of 45 consecutive patients who received an allo-HCT (n = 37) or an auto-HCT (n = 8) regardless of age, pre-transplant therapies, or remission status at transplantation. Allo-HCT recipients were younger (50 (14-74) vs. 67 (45-72) years, P = 0·01) and had 1-year and 3-year OS of 68% [95% confidence interval (CI) = 49-81%] and 58% (95% CI = 38-75%), respectively. Allo-HCT in first complete remission (CR1) yielded superior 3-year OS (versus not in CR1) [74% (95% CI = 48-89%) vs. 0, P < 0·0001]. Allo-HCT outcomes were not impacted by regimen intensity [3-year OS for myeloablative conditioning = 61% (95% CI = 28-83%) vs. reduced-intensity conditioning = 55% (95% CI = 28-76%)]. One-year OS for auto-HCT recipients was 11% (95% CI = 8-50%). These results demonstrate efficacy of allo-HCT in BPDCN, especially in patients in CR1. Pertaining to auto-HCT, our results suggest lack of efficacy against BPDCN, but this observation is limited by the small sample size. Larger prospective studies are needed to better define the role of HCT in BPDCN.
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Affiliation(s)
- Mohamed A Kharfan-Dabaja
- Deptartment of Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Monzr M Al Malki
- Deptartment of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Uday Deotare
- Leukemia Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Renju V Raj
- Deptartment of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Najla El-Jurdi
- Div. of Hematology-Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Navneet Majhail
- Deptartment of Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamad A Cherry
- Section of Hematology-Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Qaiser Bashir
- Division of Cancer Medicine, Deptartment of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Justin Darrah
- Deptartment of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Taiga Nishihori
- Deptartment of Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Hassan Sibai
- Leukemia Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mehdi Hamadani
- Deptartment of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcos de Lima
- Div. of Hematology-Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Aaron T Gerds
- Deptartment of Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - George Selby
- Section of Hematology-Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Muzaffar H Qazilbash
- Division of Cancer Medicine, Deptartment of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen J Forman
- Deptartment of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Ernesto Ayala
- Deptartment of Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Jeffrey H Lipton
- Leukemia Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Parameswaran N Hari
- Deptartment of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tariq Muzzafar
- Deptartment of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Ling Zhang
- Deptartment of Hematopathology, Moffitt Cancer Center, Tampa, FL, USA
| | - Horatiu Olteanu
- Deptartment of Hematopathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Janelle Perkins
- College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Lubomir Sokol
- Deptartment of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Ambuj Kumar
- Program for Comparative Effectiveness Research, University of South Florida College of Medicine, Tampa, FL, USA
| | - Sairah Ahmed
- Division of Cancer Medicine, Deptartment of Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX, USA
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Jerkins JH, Hamadani M, Zook F, Epperla N, Shaw BE, Saber W, Rizzo JD, Pasquini M, Chhabra S, Drobyski WR, Hari PN, Shah NN. Alpha-1-antitrypsin for the treatment of steroid-refractory acute gastrointestinal graft-versus-host disease. Am J Hematol 2017; 92:E610-E611. [PMID: 28699171 DOI: 10.1002/ajh.24850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 11/07/2022]
Affiliation(s)
- James H. Jerkins
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
| | - Mehdi Hamadani
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
- Medical College of Wisconsin; Center for International Blood and Marrow Transplant Research; Milwaukee Wisconsin
| | - Felicia Zook
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
| | - Narendranath Epperla
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
| | - Bronwen E. Shaw
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
- Medical College of Wisconsin; Center for International Blood and Marrow Transplant Research; Milwaukee Wisconsin
| | - Wael Saber
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
- Medical College of Wisconsin; Center for International Blood and Marrow Transplant Research; Milwaukee Wisconsin
| | - J. Douglas Rizzo
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
- Medical College of Wisconsin; Center for International Blood and Marrow Transplant Research; Milwaukee Wisconsin
| | - Marcelo Pasquini
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
- Medical College of Wisconsin; Center for International Blood and Marrow Transplant Research; Milwaukee Wisconsin
| | - Saurabh Chhabra
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
| | - William R. Drobyski
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
| | - Parameswaran N. Hari
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
- Medical College of Wisconsin; Center for International Blood and Marrow Transplant Research; Milwaukee Wisconsin
| | - Nirav N. Shah
- Medical College of Wisconsin; Blood and Marrow Transplant Program; Milwaukee Wisconsin
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Gajewski JL, McClellan MB, Majhail NS, Hari PN, Bredeson CN, Maziarz RT, LeMaistre CF, Lill MC, Farnia SH, Komanduri KV, Boo MJ. Payment and Care for Hematopoietic Cell Transplantation Patients: Toward a Specialized Medical Home for Complex Care Patients. Biol Blood Marrow Transplant 2017; 24:4-12. [PMID: 28963077 DOI: 10.1016/j.bbmt.2017.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/20/2017] [Indexed: 12/15/2022]
Abstract
Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time. Payment is linked to quality measures, including proportion of care delivered according to predefined pathways and demonstrated impact on outcomes. Some medical homes also include opportunities for shared savings by reducing overall costs of care. Recent proposals have suggested expanding the medical home model to specialized populations with complex needs because primary care teams may not have the facilities or the requisite expertise for their unique needs. An example of a successful care model that may provide valuable lessons for those creating specialty medical home models already exists in many hematopoietic cell transplantation (HCT) centers that deliver multidisciplinary, coordinated, and highly specialized care. The integration of care delivery in HCT centers has been driven by the specialty care their patients require and by the payment methodology preferred by the commercial payers, which has included bundling of both inpatient and outpatient care in the peritransplant interval. Commercial payers identify qualified HCT centers based on accreditation status and comparative performance, enabled in part by center-level comparative performance data available within a national outcomes database mandated by the Stem Cell Therapeutic and Research Act of 2005. Standardization across centers has been facilitated via voluntary accreditation implemented by Foundation for the Accreditation of Cell Therapy. Payers have built on these community-established programs and use public outcomes and program accreditation as standards necessary for inclusion in specialty care networks and contracts. Although HCT centers have not been described as medical homes, most HCT providers have already developed the structures that address critical requirements of MACRA for medical homes.
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Affiliation(s)
- James L Gajewski
- Department of Health Policy and Strategic Relations, American Society for Blood and Marrow Transplantation, Chicago, Illinois.
| | - Mark B McClellan
- Duke University Margolis Center for Health Policy, Durham, North Carolina
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Division of Hematology & Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Richard T Maziarz
- Stem Cell Transplantation Program, Division of Hematology & Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Michael C Lill
- Stem Cell and Bone Marrow Transplant Program, Division of Hematology and Medical Oncology, Samuel Oschin Comprehensive Cancer Center, Los Angeles, California
| | - Stephanie H Farnia
- Department of Health Policy and Strategic Relations, American Society for Blood and Marrow Transplantation, Chicago, Illinois
| | - Krishna V Komanduri
- Adult Hematopoietic Stem Cell Transplant Program, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Michael J Boo
- National Marrow Donor Program, Minneapolis, Minnesota
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Kapke JT, Epperla N, Shah N, Richardson K, Carrum G, Hari PN, Pingali SR, Hamadani M, Karmali R, Fenske TS. Effect of Routine Surveillance Imaging on the Outcomes of Patients With Classical Hodgkin Lymphoma After Autologous Hematopoietic Cell Transplantation. Clin Lymphoma Myeloma Leuk 2017; 17:408-414. [PMID: 28756899 DOI: 10.1016/j.clml.2017.05.005] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/14/2017] [Accepted: 05/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with relapsed and refractory classical Hodgkin lymphoma (cHL) are often treated with autologous hematopoietic cell transplantation (auto-HCT). After auto-HCT, most transplant centers implement routine surveillance imaging to monitor for disease relapse; however, there is limited evidence to support this practice. PATIENTS AND METHODS In this multicenter, retrospective study, we identified cHL patients (n = 128) who received auto-HCT, achieved complete remission (CR) after transplantation, and then were followed with routine surveillance imaging. Of these, 29 (23%) relapsed after day 100 after auto-HCT. Relapse was detected clinically in 14 patients and with routine surveillance imaging in 15 patients. RESULTS When clinically detected relapse was compared with to radiographically detected relapse respectively, the median overall survival (2084 days [range, 225-4161] vs. 2737 days [range, 172-2750]; P = .51), the median time to relapse (247 days [range, 141-3974] vs. 814 days [range, 96-1682]; P = .30) and the median postrelapse survival (674 days [range, 13-1883] vs. 1146 days [range, 4-2548]; P = .52) were not statistically different. In patients who never relapsed after auto-HCT, a median of 4 (range, 1-25) surveillance imaging studies were performed over a median follow-up period of 3.5 years. CONCLUSION A minority of patients with cHL who achieve CR after auto-HCT will ultimately relapse. Surveillance imaging detected approximately half of relapses; however, outcomes were similar for those whose relapse was detected using routine surveillance imaging versus detected clinically in between surveillance imaging studies. There appears to be limited utility for routine surveillance imaging in cHL patients who achieve CR after auto-HCT.
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Affiliation(s)
- Jonathan T Kapke
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Narendranath Epperla
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Namrata Shah
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - George Carrum
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, and Houston Methodist Hospital, Houston, TX
| | - Parameswaran N Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Sai R Pingali
- Division of Hematology and Oncology, Houston Methodist Cancer Center, Houston, TX
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Reem Karmali
- Division of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, IL
| | - Timothy S Fenske
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI.
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30
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Schriber JR, Hari PN, Ahn KW, Fei M, Costa LJ, Kharfan-Dabaja MA, Angel-Diaz M, Gale RP, Ganguly S, Girnius SK, Hashmi S, Pawarode A, Vesole DH, Wiernik PH, Wirk BM, Marks DI, Nishihori T, Olsson RF, Usmani SZ, Mark TM, Nieto YL, D'Souza A. Hispanics have the lowest stem cell transplant utilization rate for autologous hematopoietic cell transplantation for multiple myeloma in the United States: A CIBMTR report. Cancer 2017; 123:3141-3149. [PMID: 28472539 DOI: 10.1002/cncr.30747] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [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: 02/08/2017] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Race/ethnicity remains an important barrier in clinical care. The authors investigated differences in the receipt of autologous hematopoietic cell transplantation (AHCT) among patients with multiple myeloma (MM) and outcomes based on race/ethnicity in the United States. METHODS The Center for International Blood and Marrow Transplant Research database was used to identify 28,450 patients who underwent AHCT for MM from 2008 through 2014. By using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registries, the incidence of MM was calculated, and a stem cell transplantation utilization rate (STUR) was derived. Post-AHCT outcomes were analyzed among patients ages 18 to 75 years who underwent melphalan-conditioned peripheral cell grafts (N = 24,102). RESULTS The STUR increased across all groups from 2008 to 2014. The increase was substantially lower among Hispanics (range, 8.6%-16.9%) and non-Hispanic blacks (range, 12.2%-20.5%) compared with non-Hispanic whites (range, 22.6%-37.8%). There were 18,046 non-Hispanic whites, 4123 non-Hispanic blacks, and 1933 Hispanic patients. The Hispanic group was younger (P < .001). Fewer patients older than 60 years underwent transplantation among Hispanics (39%) and non-Hispanic blacks (42%) compared with non-Hispanic whites (56%). A Karnofsky score <90% and a hematopoietic cell transplantation comorbidity index score >3 were more common in non-Hispanic blacks compared with Hispanic and non-Hispanic whites (P < .001). More Hispanics (57%) versus non-Hispanic blacks (54%) and non-Hispanic whites (52%; P < .001) had stage III disease. More Hispanics (48%) versus non-Hispanic blacks (45%) and non-Hispanic whites (44%) had a very good partial response or better before transplantation (P = .005). Race/ethnicity did not impact post-AHCT outcomes. CONCLUSIONS Although the STUR increased, it remained low and was significantly lower among Hispanics followed by non-Hispanic blacks compared with non-Hispanic whites. Race/ethnicity did not impact transplantation outcomes. Efforts to increase the rates of transplantation for eligible patients who have MM, with an emphasis on groups that underuse transplantation, are warranted. Cancer 2017;123:3141-9. © 2017 American Cancer Society.
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Affiliation(s)
- Jeffrey R Schriber
- Cancer Transplant Institute, Virginia G. Piper Cancer Center, Scottsdale, Arizona.,Arizona Oncology, Scottsdale, Arizona
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mingwei Fei
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Luciano J Costa
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mohamad A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Miguel Angel-Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Robert P Gale
- Hematology Research Center, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Siddharatha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Saulius K Girnius
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, Michigan
| | - David H Vesole
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey
| | - Peter H Wiernik
- Division of Hematology/Oncology, Our Lady of Mercy Medical Center, Bronx, New York
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol National Health Service Trust, Bristol, United Kingdom
| | - 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 Institute, Stockholm, Sweden.,Center for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Saad Z Usmani
- Department of Hematology and Medical Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Tomer M Mark
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yago L Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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31
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Kanate AS, Hari PN, Pasquini MC, Visotcky A, Ahn KW, Boyd J, Guru Murthy GS, Rizzo JD, Saber W, Drobyski W, Michaelis L, Atallah E, Carlson KS, D'Souza A, Fenske TS, Cumpston A, Bunner P, Craig M, Horowitz MM, Hamadani M. Recipient Immune Modulation with Atorvastatin for Acute Graft-versus-Host Disease Prophylaxis after Allogeneic Transplantation. Biol Blood Marrow Transplant 2017; 23:1295-1302. [PMID: 28412518 DOI: 10.1016/j.bbmt.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 03/10/2017] [Accepted: 04/09/2017] [Indexed: 11/16/2022]
Abstract
Atorvastatin administration to both the donors and recipients of matched related donor (MRD) allogeneic hematopoietic cell transplantation (allo-HCT) as acute graft-versus-host disease (GVHD) prophylaxis has been shown to be safe and effective. However, its efficacy as acute GVHD prophylaxis when given only to allo-HCT recipients is unknown. We conducted a phase II study to evaluate the safety and efficacy of atorvastatin-based acute GVHD prophylaxis given only to the recipients of MRD (n = 30) or matched unrelated donor (MUD) (n = 39) allo-HCT, enrolled in 2 separate cohorts. Atorvastatin (40 mg/day) was administered along with standard GVHD prophylaxis consisting of tacrolimus and methotrexate. All patients were evaluable for acute GVHD. The cumulative incidences of grade II to IV acute GVHD at day +100 in the MRD and MUD cohorts were 9.9% (95% confidence interval [CI], 0 to 20%) and 29.6% (95% CI,15.6% to 43.6%), respectively. The cumulative incidences of grade III and IV acute GVHD at day +100 in the MRD and MUD cohorts were 3.4% (95% CI, 0 to 9.7%) and 18.3% (95% CI, 6.3% to 30.4%), respectively. The corresponding rates of moderate/severe chronic GVHD at 1 year were 28.1% (95% CI, 11% to 45.2%) and 38.9% (95% CI, 20.9% to 57%), respectively. In the MRD cohort, the 1-year nonrelapse mortality, relapse rate, progression-free survival, and overall survival were 6.7% (95% CI, 0 to 15.4%), 43.3% (95% CI, 24.9% to 61.7%), 50% (95% CI, 32.1% to 67.9%), and 66.7% (95% CI, 49.8% to 83.6%), respectively. The respective figures for the MUD cohort were 10.3% (95% CI, 8% to 19.7%), 20.5% (95% CI, 7.9% to 33.1%), 69.2% (95% CI, 54.7% to 83.7%), and 79.5% (95% CI, 66.8% to 92.2%), respectively. No grade 4 toxicities attributable to atorvastatin were seen. In conclusion, the addition of atorvastatin to standard GVHD prophylaxis in only the recipients of MRD and MUD allo-HCT appears to be feasible and safe. The preliminary efficacy seen here warrants confirmation in randomized trials.
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Affiliation(s)
- Abraham S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Parameswaran N Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo C Pasquini
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alexis Visotcky
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kwang W Ahn
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer Boyd
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - J Douglas Rizzo
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wael Saber
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William Drobyski
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Michaelis
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ehab Atallah
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karen S Carlson
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy S Fenske
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aaron Cumpston
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Pamela Bunner
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Michael Craig
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Mary M Horowitz
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Epperla N, Hamadani M, Cashen AF, Ahn KW, Oak E, Kanate AS, Calzada O, Cohen JB, Farmer L, Ghosh N, Tallarico M, Nabhan C, Costa LJ, Kenkre VP, Hari PN, Fenske TS. Predictive factors and outcomes for ibrutinib therapy in relapsed/refractory mantle cell lymphoma-a "real world" study. Hematol Oncol 2017; 35:528-535. [PMID: 28066928 DOI: 10.1002/hon.2380] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 01/30/2023]
Abstract
Ibrutinib has demonstrated significant activity in relapsed/refractory mantle cell lymphoma (MCL) in clinical trials. However, the impact of hematopoietic cell transplantation on the outcomes of ibrutinib and the predictive factors for ibrutinib response has not been well studied. Hence, we conducted a multicenter retrospective study of MCL patients who received ibrutinib to (1) determine the overall response rate (ORR), duration of response (DOR), progression-free survival (PFS), and overall survival (OS) of ibrutinib in routine clinical practice, (2) examine characteristics predictive of response to ibrutinib therapy, and (3) describe the outcomes of patients failing ibrutinib. Ninety-seven patients met the eligibility criteria. Overall response rate and median DOR to ibrutinib were 65% and 17 months, respectively. Only lack of primary refractory disease was predictive of ibrutinib response on multivariate analysis. Twenty-nine patients received postibrutinib therapies, with an ORR of 48% and a median DOR of 3 months. The median OS and PFS for the entire group (n = 97) was 22 and 15 months, respectively. On multivariate analysis, ibrutinib response, low MCL international prognostic index, and absence of primary refractory disease were predictors of better PFS, while ibrutinib response and Eastern Cooperative Oncology Group performance status ≤1 were predictors of better OS. The median OS postibrutinib failure was 2.5 months. Our results confirm the high ORR and DOR of ibrutinib in MCL and that prior hematopoietic cell transplantation does not negatively influence ibrutinib outcomes. Survival following ibrutinib failure is poor with no specific subsequent therapy showing superior activity in this setting. As a result, for select (transplant eligible) patients, allogeneic transplant should be strongly considered soon after ibrutinib response is documented to provide durable responses.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amanda F Cashen
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kwang W Ahn
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eunhye Oak
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Abraham S Kanate
- Division of Hematology and Oncology, West Virginia University, Morgantown, WV, USA
| | - Oscar Calzada
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Luke Farmer
- Department of Hematology and Oncology, Levine Cancer Institute/Carolinas HealthCare System, Charlotte, NC, USA
| | - Nilanjan Ghosh
- Department of Hematology and Oncology, Levine Cancer Institute/Carolinas HealthCare System, Charlotte, NC, USA
| | - Michael Tallarico
- Division of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Chadi Nabhan
- Division of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Luciano J Costa
- Bone Marrow Transplantation and Cell Therapy Program, University of Alabama, Birmingham, AL, USA
| | - Vaishalee P Kenkre
- Division of Hematology and Oncology, University of Wisconsin, Madison, WI, USA
| | - Parameswaran N Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy S Fenske
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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33
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Zheng C, Dai R, Hari PN, Zhang MJ. Instrumental variable with competing risk model. Stat Med 2017; 36:1240-1255. [PMID: 28064466 DOI: 10.1002/sim.7205] [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: 03/06/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 11/10/2022]
Abstract
In this paper, we discuss causal inference on the efficacy of a treatment or medication on a time-to-event outcome with competing risks. Although the treatment group can be randomized, there can be confoundings between the compliance and the outcome. Unmeasured confoundings may exist even after adjustment for measured covariates. Instrumental variable methods are commonly used to yield consistent estimations of causal parameters in the presence of unmeasured confoundings. On the basis of a semiparametric additive hazard model for the subdistribution hazard, we propose an instrumental variable estimator to yield consistent estimation of efficacy in the presence of unmeasured confoundings for competing risk settings. We derived the asymptotic properties for the proposed estimator. The estimator is shown to be well performed under finite sample size according to simulation results. We applied our method to a real transplant data example and showed that the unmeasured confoundings lead to significant bias in the estimation of the effect (about 50% attenuated). Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Cheng Zheng
- Joseph. J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, U.S.A
| | - Ran Dai
- Department of Statistics, University of Chicago, Chicago, IL, U.S.A
| | - Parameswaran N Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - Mei-Jie Zhang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, U.S.A
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34
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Epperla N, Shah N, Hamadani M, Richardson K, Kapke JT, Patel A, Teegavarapu SP, Carrum G, Hari PN, Pingali SR, Karmali R, Fenske TS. Impact of Routine Surveillance Imaging on Outcomes of Patients With Diffuse Large B-Cell Lymphoma After Autologous Hematopoietic Cell Transplantation. Clinical Lymphoma Myeloma and Leukemia 2016; 16:672-678. [DOI: 10.1016/j.clml.2016.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/13/2016] [Accepted: 08/18/2016] [Indexed: 01/26/2023]
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35
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Epperla N, Pasquini M, Pierce K, Drobyski WR, Rizzo JD, Horowitz MM, Saber W, Zellner K, Ramirez S, Bartz K, Raj RV, Hari PN, Hamadani M. Salvage haploidentical hematopoietic cell transplantation for graft rejection following a prior haploidentical allograft. Bone Marrow Transplant 2016; 52:147-150. [DOI: 10.1038/bmt.2016.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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36
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Dhakal B, D'Souza A, Martens M, Kapke J, Harrington AM, Pasquini M, Saber W, Drobyski WR, Zhang MJ, Hamadani M, Hari PN. Allogeneic Hematopoietic Cell Transplantation in Multiple Myeloma: Impact of Disease Risk and Post Allograft Minimal Residual Disease on Survival. Clinical Lymphoma Myeloma and Leukemia 2016; 16:379-86. [DOI: 10.1016/j.clml.2016.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/26/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
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37
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Ghosh N, Karmali R, Rocha V, Ahn KW, DiGilio A, Hari PN, Bachanova V, Bacher U, Dahi P, de Lima M, D'Souza A, Fenske TS, Ganguly S, Kharfan-Dabaja MA, Prestidge TD, Savani BN, Smith SM, Sureda AM, Waller EK, Jaglowski S, Herrera AF, Armand P, Salit RB, Wagner-Johnston ND, Fuchs E, Bolaños-Meade J, Hamadani M. Reduced-Intensity Transplantation for Lymphomas Using Haploidentical Related Donors Versus HLA-Matched Sibling Donors: A Center for International Blood and Marrow Transplant Research Analysis. J Clin Oncol 2016; 34:3141-9. [PMID: 27269951 DOI: 10.1200/jco.2015.66.3476] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Related donor haploidentical hematopoietic cell transplantation (Haplo-HCT) using post-transplantation cyclophosphamide (PT-Cy) is increasingly used in patients lacking HLA-matched sibling donors (MSD). We compared outcomes after Haplo-HCT using PT-Cy with MSD-HCT in patients with lymphoma, using the Center for International Blood and Marrow Transplant Research registry. MATERIALS AND METHODS We evaluated 987 adult patients undergoing either Haplo-HCT (n = 180) or MSD-HCT (n = 807) following reduced-intensity conditioning regimens. The haploidentical group received graft-versus-host disease (GVHD) prophylaxis with PT-Cy with or without a calcineurin inhibitor and mycophenolate. The MSD group received calcineurin inhibitor-based GVHD prophylaxis. RESULTS Median follow-up of survivors was 3 years. The 28-day neutrophil recovery was similar in the two groups (95% v 97%; P = .31). The 28-day platelet recovery was delayed in the haploidentical group compared with the MSD group (63% v 91%; P = .001). Cumulative incidence of grade II to IV acute GVHD at day 100 was similar between the two groups (27% v 25%; P = .84). Cumulative incidence of chronic GVHD at 1 year was significantly lower after Haplo-HCT (12% v 45%; P < .001), and this benefit was confirmed on multivariate analysis (relative risk, 0.21; 95% CI, 0.14 to 0.31; P < .001). For Haplo-HCT v MSD-HCT, 3-year rates of nonrelapse mortality (15% v 13%; P = .41), relapse/progression (37% v 40%; P = .51), progression-free survival (48% v 48%; P = .96), and overall survival (61% v 62%; P = .82) were similar. Multivariate analysis showed no significant difference between Haplo-HCT and MSD-HCT in terms of nonrelapse mortality (P = .06), progression/relapse (P = .10), progression-free survival (P = .83), and overall survival (P = .34). CONCLUSION Haplo-HCT with PT-Cy provides survival outcomes comparable to MSD-HCT, with a significantly lower risk of chronic GVHD.
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Affiliation(s)
- Nilanjan Ghosh
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Reem Karmali
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Vanderson Rocha
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Kwang Woo Ahn
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Alyssa DiGilio
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Parameswaran N Hari
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Veronika Bachanova
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Ulrike Bacher
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Parastoo Dahi
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Marcos de Lima
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Anita D'Souza
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Timothy S Fenske
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Siddhartha Ganguly
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Mohamed A Kharfan-Dabaja
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Tim D Prestidge
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Bipin N Savani
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Sonali M Smith
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Anna M Sureda
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Edmund K Waller
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Samantha Jaglowski
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Alex F Herrera
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Philippe Armand
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Rachel B Salit
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Nina D Wagner-Johnston
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Ephraim Fuchs
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Javier Bolaños-Meade
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Mehdi Hamadani
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD.
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Costa LJ, Hari PN, Kumar SK. Differences between unselected patients and participants in multiple myeloma clinical trials in US: a threat to external validity. Leuk Lymphoma 2016; 57:2827-2832. [PMID: 27104965 DOI: 10.3109/10428194.2016.1170828] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
External validity of clinical trials is affected by dissimilarities between study subjects and patient population. We identified 128 manuscripts (8,869 subjects) published between 2007 and 2014 reporting results of multiple myeloma (MM) trials performed entirely in the US. Characteristics of subjects were compared with unselected patients from SEER-18. Median of median age of subjects was 61 years vs. median age of unselected patients of 69 years. Trial subjects with untreated MM had less advanced stage than unselected patients. Racial-ethnic composition was informed in only 51 (39.8%) trials. Industry-sponsored trials were more likely to report accrual of minorities than National Cancer Institute (NCI) or investigator-sponsored trials. The observed/expected minority accrual was 0.52 (95% CI 0.49-0.55), being lower (0.43) in investigator-sponsored and higher (0.61) in industry-sponsored trials. We concluded that minorities, older individuals and persons with more advanced disease are underrepresented in MM trials, potentially compromising external validity of results.
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Affiliation(s)
- Luciano J Costa
- a Division of Hematology and Oncology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Parameswaran N Hari
- b Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin , Center for International Blood and Marrow Transplant Research , Milwaukee , WI , USA
| | - Shaji K Kumar
- c Division of Hematology , Mayo Clinic College of Medicine , Rochester , MN , USA
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Keever-Taylor CA, Jones L, Padmanabhan A, Heimfeld S, Sandmaier BM, Hari PN, Thakar M. Consistent Collection and Processing of Non-Mobilized Mononuclear Cell, Apheresis Products from HLA Haploidentical Bone Marrow Donors for Sequential CD3+ T-Cell Depletion and CD56+ NK Cell Enrichment. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thompson JR, Drobyski W, D'Souza A, Fenske TS, Hamadani M, Hari PN, Pasquini MC, Saber W, Rizzo JD. Etanercept for Late Onset Idiopathic Pneumonia Syndrome. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.859] [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]
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Hari PN, Song K, Bensinger W, Siegel D, Davies F, Huang M, Iskander K, Aggarwal S, Abonour R. Efficacy and Safety of Carfilzomib, Lenalidomide, and Dexamethasone Versus Lenalidomide and Dexamethasone in Patients with Relapsed Multiple Myeloma after Autologous Stem Cell Transplantation: Secondary Analysis from the Phase 3 Aspire Study (NCT01080391). Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.1107] [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]
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Singh M, Dhakal B, Shrestha A, Atallah E, Carlson K, Pasquini MC, Rein L, Banerjee A, Esselmann J, Ramirez S, Zellner K, Essenmacher A, Hari PN, Michaelis LC. Salvage Therapy with Hypomethylating Agents (HMA) and/or Lenalidomide (len) for Patients with Myelodysplastic Syndrome (MDS) or Acute Myeloid Leukemia (AML) Relapse Following Allogeneic Stem Cell Transplantation (allo-SCT). Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.855] [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]
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Thakar M, Hari PN, Keever-Taylor CA, Jones L, Heimfeld S, Sandmaier BM. Donor Natural Killer (NK) Cell Immunotherapy Following Non-Myeloablative HLA-Haploidentical Hematopoietic Cell Transplantation (HCT) Improves Relapse and Progression Free Survival (PFS) in Patients with Hematologic Malignancies. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cornell RF, Bachanova V, D'Souza A, Ahn KW, Huang J, Krishnan A, Gasparetto C, Nieto Y, Mark TM, Hari PN. Outcomes after Allogeneic Transplant for Lymphoplasmacytic Lymphoma/ Waldenstrom Macroglobulinemia (LPL/WM): A Center for International Blood and Marrow Transplant Research Analysis. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hamadani M, Pasquini MC, Visotcky A, Ahn KW, Horowitz MM, Boyd J, Rizzo JD, Saber W, Drobyski W, Arce-lara C, D'Souza A, Fenske TS, Cumpston A, Bunner P, Craig M, Hari PN, Kanate AS. Prospective, Multicenter Clinical Trial of Atorvastatin-Based Acute Graft-Versus-Host-Disease (aGVHD) Prophylaxis in Recipients of HLA-Matched Related Donor (MRD) and Matched Unrelated Donor (MUD) Allogeneic Hematopoietic Cell Transplantation (alloHCT). Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Weil EM, Zook F, Oxencis C, Urmanski A, Waggoner M, Canadeo A, Hari PN. Evaluation of the Pharmacokinetics and Efficacy of a Busulfan Test Dose in Adult Patients Undergoing Myeloablative Stem Cell Transplant. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dhakal B, Vesole DH, Hari PN. Allogeneic stem cell transplantation for multiple myeloma: is there a future? Bone Marrow Transplant 2016; 51:492-500. [DOI: 10.1038/bmt.2015.325] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/11/2015] [Accepted: 11/14/2015] [Indexed: 12/31/2022]
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Klyuchnikov E, Bacher U, Woo Ahn K, Carreras J, Kröger NM, Hari PN, Ku GH, Ayala E, Chen AI, Chen YB, Cohen JB, Freytes CO, Gale RP, Kamble RT, Kharfan-Dabaja MA, Lazarus HM, Martino R, Mussetti A, Savani BN, Schouten HC, Usmani SZ, Wiernik PH, Wirk B, Smith SM, Sureda A, Hamadani M. Long-term survival outcomes of reduced-intensity allogeneic or autologous transplantation in relapsed grade 3 follicular lymphoma. Bone Marrow Transplant 2015; 51:58-66. [PMID: 26437062 PMCID: PMC4703480 DOI: 10.1038/bmt.2015.223] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 06/30/2015] [Revised: 07/29/2015] [Accepted: 08/15/2015] [Indexed: 01/04/2023]
Abstract
Grade 3 follicular lymphoma (FL) has aggressive clinical behavior. To evaluate the optimal first transplantation approach in relapsed/refractory grade 3 FL patients, we compared the long-term outcomes after allogeneic (allo-) vs autologous hematopoietic cell transplantation (auto-HCT) in the rituximab era. A total of 197 patients undergoing first reduced-intensity conditioning (RIC) allo-HCT or first auto-HCT during 2000-2012 were included. Rituximab-naive patients were excluded. Allo-HCT recipients were younger, more heavily pretreated and had a longer interval between diagnosis and HCT. The 5-year probabilities of non-relapse mortality (NRM), relapse/progression, PFS and overall survival (OS) for auto-HCT vs allo-HCT groups were 4% vs 27% (P<0.001), 61% vs 20% (P<0.001), 36% vs 51% (P=0.07) and 59% vs 54% (P=0.7), respectively. On multivariate analysis, auto-HCT was associated with reduced risk of NRM (relative risk (RR)=0.20; P=0.001). Within the first 11 months post HCT, auto- and allo-HCT had similar risks of relapse/progression and PFS. Beyond 11 months, auto-HCT was associated with higher risk of relapse/progression (RR=21.3; P=0.003) and inferior PFS (RR=3.2; P=0.005). In the first 24 months post HCT, auto-HCT was associated with improved OS (RR=0.42; P=0.005), but in long-time survivors (beyond 24 months) it was associated with inferior OS (RR=3.6; P=0.04). RIC allo-HCT as the first transplant approach can provide improved PFS and OS, in long-term survivors.
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Affiliation(s)
- E Klyuchnikov
- Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | - U Bacher
- Department for Hematology/Oncology, Georg August University Göttingen, Göttingen, Germany
| | - K Woo Ahn
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Carreras
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - N M Kröger
- Department for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | - P N Hari
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - G H Ku
- Division of Blood and Marrow Transplantation, Department of Medicine, University of California, San Diego, CA, USA
| | - E Ayala
- Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - A I Chen
- Oregon Health and Science University, Portland, OR, USA
| | - Y-B Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - J B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - C O Freytes
- South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - R P Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College of London, London, UK
| | - R T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - M A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - H M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - R Martino
- Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Mussetti
- SC Ematologia e Trapianto Midollo Osseo, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - B N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - H C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
| | - S Z Usmani
- Department of Hematology - Medical Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - P H Wiernik
- Our Lady of Mercy Medical Center, Bronx, NY, USA
| | - B Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - S M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
| | - A Sureda
- Servei d'Hematologia, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain.,European Group for Blood and Marrow Transplantation, Barcelona, Spain
| | - M Hamadani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Epperla N, Fenske TS, Hari PN, Hamadani M. Recent advances in post autologous transplantation maintenance therapies in B-cell non-Hodgkin lymphomas. World J Transplant 2015; 5:81-88. [PMID: 26421260 PMCID: PMC4580930 DOI: 10.5500/wjt.v5.i3.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/27/2015] [Accepted: 06/19/2015] [Indexed: 02/05/2023] Open
Abstract
Lymphomas constitute the second most common indication for high dose therapy (HDT) followed by autologous hematopoietic cell transplantation (auto-HCT). The intent of administering HDT in these heterogeneous disorders varies from cure (e.g., in relapsed aggressive lymphomas) to disease control (e.g., most indolent lymphomas). Regardless of the underlying histology or remission status at transplantation, disease relapse remains the number one cause of post auto-HCT therapy failure and mortality. The last decade has seen a proliferation of clinical studies looking at prevention of post auto-HCT therapy failure with various maintenance strategies. The benefit of such therapies is in turn dependent on disease histology and timing of transplantation. In relapsed, chemosensitive diffuse large B-cell lymphoma (DLBCL), although post auto-HCT maintenance rituximab seems to be safe and feasible, it does not provide improved survival outcomes and is not recommended. The preliminary results with anti- programmed death -1 (PD-1) antibody therapy as post auto-HCT maintenance in DLBCL is promising but requires randomized validation. Similarly in follicular lymphoma, maintenance therapies including rituximab following auto-HCT should be considered investigational and offered only on a clinical trial. Rituximab maintenance results in improved progression-free survival but has not yet shown to improve overall survival in mantle cell lymphoma (MCL), but given the poor prognosis with post auto-HCT failure in MCL, maintenance rituximab can be considered on a case-by-case basis. Ongoing trials evaluating the efficacy of post auto-HCT maintenance with novel compounds (e.g., immunomodulators, PD-1 inhibitors, proteasome inhibitors and bruton’s tyrosine kinase inhibitors) will likely change the practice landscape in the near future for B cell non-Hodgkin lymphomas patients following HDT and auto-HCT.
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