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Stuver R, Mian A, Brown S, Devlin S, Caimi PF, Chinapen S, Dahi P, Dean R, Epstein-Peterson ZD, Hill B, Horwitz SM, Lahoud O, Lin R, Moskowitz AJ, Sauter C, Shah G, Winter A, Jagadeesh D, Scordo M. BEAM versus pharmacokinetics-directed BuCyVP16 conditioning for patients with peripheral T-cell lymphoma undergoing high-dose therapy with autologous hematopoietic cell transplantation. Am J Hematol 2024; 99:1180-1183. [PMID: 38526002 PMCID: PMC11096040 DOI: 10.1002/ajh.27291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Robert Stuver
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Agrima Mian
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Samantha Brown
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Sean Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Paolo F. Caimi
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Stephanie Chinapen
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
| | - Parastoo Dahi
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Robert Dean
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | | | - Brian Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Steven M. Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Oscar Lahoud
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Richard Lin
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Alison J. Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Craig Sauter
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Gunjan Shah
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Alison Winter
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic
| | - Michael Scordo
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center
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2
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Fingrut WB, Davis E, Archer A, Brown S, Devlin SM, Nhaissi M, Rapoport C, Chinapen S, Kelly A, Wells DS, Scaradavou A, Gyurkocza B, Papadopoulos EB, Politikos I, Shaffer BC, Barker J. Racial/ ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation. Blood Adv 2024:bloodadvances.2023012385. [PMID: 38429097 DOI: 10.1182/bloodadvances.2023012385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/22/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024] Open
Abstract
Despite the global unrelated donor (URD) registry size, the degree to which URD availability is a transplant barrier is not established. We evaluated the availability of 3,843 URDs requested for 455 diverse adult patients (predominantly with acute leukemia). URDs for non-Europeans were more likely to be domestic and had markedly lower Donor Readiness Scores. Of URDs requested for confirmatory HLA-typing (CT) alone (i.e. without simultaneous workup), 1,894/3,529 (54%) were available. Availability of domestic URDs was 45%. Donor Readiness Score was highly predictive of CT availability. Compared with Europeans (n=335), more non-European patients (n=120) had >10 URDs requested and <5 available. Of workup requests (after CT or CT-workup), <70% (604/889, 68%) were available. More non-Europeans had <2 URDs available. URD availability for CT was markedly worse for non-Europeans, with availabilities for African, non-Black Hispanic, and Asian patients of 150/458 (33%), 120/258 (47%) and 119/270 (44%), respectively, with further decrements in URD workup availability. Our data suggest the functional size of the URD pool is much smaller than appreciated, mandating major operational changes for transplant Centers and donor registries. Likelihood of donor availability should have a high priority in donor selection. Considering patient ancestry and URD Donor Readiness Scores, Centers should pursue, and registries permit, simultaneous pursuit of many URDs, and abandon futile searches. Patients should be informed about their likelihood of donor availability and alternative options. Finally, while registries should address high URD attrition and speed procurement, use of all HLA-disparate graft types is needed to facilitate timely transplantation for all.
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Affiliation(s)
- Warren B Fingrut
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Eric Davis
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Anne Archer
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Samantha Brown
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Sean M Devlin
- Memorial Sloan-Kettering Cancer Center, New York, New York, United States
| | - Melissa Nhaissi
- Memorial Sloan Kettering Cancer Center, NY, New York, United States
| | - Candice Rapoport
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Stephanie Chinapen
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Amanda Kelly
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Deborah S Wells
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | | | | | - Ioannis Politikos
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Brian C Shaffer
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Juliet Barker
- Weill Cornell Medicine, New York, New York, United States
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3
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Fingrut WB, Davis E, Archer A, Brown S, Devlin S, Chinapen S, Scaradavou A, Politikos I, Blouin AG, Shaffer BC, Barker JN. Gender disparities in allograft access due to HLA-sensitization in multiparous women. Blood Adv 2024; 8:403-406. [PMID: 38029385 PMCID: PMC10820334 DOI: 10.1182/bloodadvances.2023011893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Warren B. Fingrut
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Davis
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anne Archer
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samantha Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Chinapen
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andromachi Scaradavou
- Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Amanda G. Blouin
- Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian C. Shaffer
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Juliet N. Barker
- Bone Marrow Transplant and Cellular Therapy Program, Department of Medicine, Weill Cornell Medicine, New York, NY
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4
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Lin A, Brown S, Chinapen S, Lee YJ, Seo SK, Ponce DM, Shahid Z, Giralt S, Papanicolaou GA, Perales MA, Shaffer BC. Patterns of CMV infection after letermovir withdrawal in recipients of posttransplant cyclophosphamide-based transplant. Blood Adv 2023; 7:7153-7160. [PMID: 37906513 PMCID: PMC10698256 DOI: 10.1182/bloodadvances.2023010966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
Reactivation of latent cytomegalovirus (CMV) is increased in recipients of allogeneic hematopoietic cell transplantation (allo-HCT) with seropositive CMV using posttransplant cyclophosphamide (PT-Cy)-based graft-versus-host disease (GVHD) prophylaxis. Letermovir, a novel DNA terminase complex inhibitor, reduces the incidence of clinically significant CMV infection (csCMVi) in this population; however, parameters that predict csCMVi after letermovir withdrawal are not well described. Here, we examined clinical and immunological parameters in 294 recipients of PT-Cy-based allo-HCT, including 157 patients with CMV, of whom 80 completed letermovir prophylaxis without csCMVi and subsequently stopped letermovir. In this population, the median duration of letermovir exposure was 203 days (interquartile range [IQR], 160-250 days). After letermovir withdrawal, the 90-day cumulative incidence of csCMVi was 23.0% (95% confidence interval, 14.3-32.8). There were no episodes of CMV end-organ disease. Hypogammaglobulinemia before letermovir discontinuation was predictive of csCMVi (hazard ratio, 0.33; 95% confidence interval, 0.12-0.93; P = .03), whereas T-cell and B-cell reconstitution before letermovir withdrawal were not predictive of csCMVi. Higher numbers of natural killer cells were found before letermovir withdrawal in patients who experienced csCMVi (median, 202 vs 160; P = .03). In recipients with seropositive CMV, CD3+CD4-CD8+ T-cell reconstitution was faster in patients with CMV regardless of letermovir exposure. Taken together, these data suggest that csCMVi after letermovir withdrawal was frequent in patients treated with PT-Cy, despite prolonged exposure. Strategies to boost CMV-specific adaptive immunity in patients with persistent hypogammaglobulinemia is a logical pathway to reduce csCMVi after letermovir withdrawal.
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Affiliation(s)
- Andrew Lin
- Adult BMT Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samantha Brown
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Chinapen
- Adult BMT Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yeon Joo Lee
- Infectious Diseases Service, Division of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Internal Medicine, Weill Cornell Medical School, New York, NY
| | - Susan K. Seo
- Infectious Diseases Service, Division of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Internal Medicine, Weill Cornell Medical School, New York, NY
| | - Doris M. Ponce
- Adult BMT Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Internal Medicine, Weill Cornell Medical School, New York, NY
| | - Zainab Shahid
- Infectious Diseases Service, Division of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Internal Medicine, Weill Cornell Medical School, New York, NY
| | - Sergio Giralt
- Adult BMT Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Internal Medicine, Weill Cornell Medical School, New York, NY
| | - Genovefa A. Papanicolaou
- Infectious Diseases Service, Division of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Internal Medicine, Weill Cornell Medical School, New York, NY
| | - Miguel-Angel Perales
- Adult BMT Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Internal Medicine, Weill Cornell Medical School, New York, NY
| | - Brian C. Shaffer
- Adult BMT Service, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Internal Medicine, Weill Cornell Medical School, New York, NY
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Fingrut WB, Chinapen S, Flynn J, Katrichis A, Stewart M, Davis E, Shaffer BC, Shah GL, Barker JN. Association between non-European ancestry, low socioeconomic status, and receipt of HLA-disparate allografts in adult BMT recipients. Blood Adv 2023; 7:3834-3837. [PMID: 37083929 PMCID: PMC10393742 DOI: 10.1182/bloodadvances.2023009955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Warren B. Fingrut
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Chinapen
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Flynn
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Angela Katrichis
- Department of Social Work, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Melissa Stewart
- Department of Social Work, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Davis
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian C. Shaffer
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Gunjan L. Shah
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Juliet N. Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medicine, New York, NY
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Fingrut WB, Gyurkocza B, Flynn J, Davis E, Devlin S, Scaradavou A, Chinapen S, Quach S, Cho C, Giralt SA, Jakubowski AA, Lin RJ, Papadopoulos EB, Perales MA, Ponce D, Shaffer BC, Tamari R, Young JW, Politikos I, Barker JN. Analysis of disparities in time to allogeneic transplantation in adults with acute myelogenous leukemia. Blood Adv 2023; 7:3824-3833. [PMID: 36240477 PMCID: PMC10393759 DOI: 10.1182/bloodadvances.2022008572] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/20/2022] Open
Abstract
Although alternative donors extend transplant access, whether recipient ancestry affects the time to allogeneic transplant is not established. We analyzed the likelihood of clinically significant delays to allograft by patient ancestry in 313 adult patients with acute myelogenous leukemia (AML) who underwent transplantation. Non-European ancestry patients (n = 99) were more likely than Europeans (n = 214) to receive HLA-mismatched donor allografts (45% vs 24%). Overall, the median time from transplant indication to allograft was 127 days (range, 57-1683). In multivariable analysis, non-Europeans had an increased risk of prolonged indication to transplant time >180 days owing to significant delays in indication to consult >90 days and consult to transplant >120 days. Compared with recipients of HLA-matched unrelated donors (URDs), HLA-mismatched adult donor recipients were at an increased risk of delayed indication to transplant, whereas HLA-identical sibling and cord blood recipients were at a lower risk. Subanalysis showed more indication to transplant delays >180 days in non-European (44%) vs European (19%) 8/8 URD recipients. Finally, the pandemic further exacerbated delays for non-Europeans. In summary, although non-European patients with AML are less likely to receive 8/8 URDs as expected, if they do, their transplants are delayed. HLA-identical siblings and cord blood facilitate the fastest transplants regardless of patient ancestry, whereas other adult donor transplants are delayed. Strategies to mitigate referral barriers, hasten donor evaluation, and use all alternative donor sources are critical to ensure timely transplantation for patients with AML.
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Affiliation(s)
- Warren B. Fingrut
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Boglarka Gyurkocza
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Davis
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andromachi Scaradavou
- Pediatric Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Chinapen
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean Quach
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Cho
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Sergio A. Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Ann A. Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Richard J. Lin
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Esperanza B. Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Doris Ponce
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Brian C. Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - James W. Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Juliet N. Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
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Fingrut WB, Davis E, Chinapen S, Naputo K, Politikos I, Scaradavou A, Barker JN. Inaccuracies in assignment of patient race and ethnicity: implications for unrelated donor searches and health care delivery. Blood Adv 2023; 7:1996-1999. [PMID: 36156708 PMCID: PMC10189370 DOI: 10.1182/bloodadvances.2022008526] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Warren B. Fingrut
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Davis
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Chinapen
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kristine Naputo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY
| | - Andromachi Scaradavou
- Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Juliet N. Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY
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Fingrut WB, Gyurkocza B, Davis E, Flynn J, Scaradavou A, Chinapen S, Naputo K, Quach S, Cho C, Giralt S, Papadopoulos EB, Perales MA, Shaffer BC, Politikos I, Barker JN. Disparities in speed to BMT consult and allograft in 279 adults with AML. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6523 Background: Whether patient (pt) ancestry impacts the time to BMT is not established. Methods: We hypothesized that non-European (non-EURO) ancestry AML pts are at increased risk of delayed time to transplant. Thus, we analyzed time to allograft (Allo) by ancestry defining delayed (late) times as: Allo Indication to BMT Consult (Ind. – Consult) > 90 days, Consult – BMT > 120 days & Allo Indication to BMT (Ind. - BMT) > 180 days. We studied pts < 70 yrs transplanted 1/2016-7/2021. Results: In 279 AML pts (median 56 yrs, range 19-69), BMT indication was date of diagnosis if ELN 2017 intermediate/ high risk &/or high risk mutations &/or sAML in 261 (94%) pts, or date of refractory/ relapsed disease in 18 (6%) pts. European (EURO) pts (n = 195, 70%; median 60 yrs) were older than non-EURO pts (n = 84, 30%; median 49 yrs), p <.001. Most HLA-matched sibling (SIB) (27/33, 82%) & 8/8 HLA-matched unrelated donor (mURD, 113/138, 82%) recipients were EURO; more non-EURO pts received HLA-disparate grafts [cord blood (CB)/ haplo/ mmURD]: 48/84 (57%) vs 55/195 (28%), p <.001. Overall, median (range) times for BMT Ind. - Consult, Consult - BMT, & Ind. - BMT were 45 (1-1127), 86 (13-1628), & 135 (23-1683) days. 15% of pts had late BMT Ind. - Consult, 27% late Consult – BMT, & 28% late Ind. - BMT. In multivariate analysis (significant variables in Table), more older pts had late Consult - BMT & Ind. - BMT; more non-EURO pts had late Ind. - Consult, Consult - BMT & Ind. – BMT; & despite mostly being non-EURO (35/67, 52%), fewer CB recipients had late Consult - BMT. In mURD pts, BMT Ind. - BMT time was delayed in non-EURO (median 182 days) vs EURO (median 128 days) pts (p = 0.04); there was no difference in CB pts (BMT Ind. - BMT EURO pt median 118 vs non-EURO pt median 108 days, p = 0.42). During the pandemic, as compared with EURO pts BMT delays were further exacerbated in non-EURO pts (Ind. - Consult median 13 & Ind. - BMT median 33 days). Conclusions: Few older non-EURO pts are allografted. Matched SIB & 8/8 mURD transplants predominantly serve EURO pts; the majority of non-EURO pts receive HLA-disparate grafts. Older age & non-EURO ancestry are associated with delayed BMT. CB transplants (CBT) are the fastest regardless of ancestry. Finally, the pandemic further exacerbated delays for non-EURO pts. Strategies to mitigate referral barriers (esp. for older non-EURO pts), prompt adult donor evaluations, efficient URD searches, & utilization of all alternative donors are critical to ensure timely BMT for all. Given the rapid availability, CBT should have high priority in high-risk or urgent pts & speedy graft procurement can compensate for late referral. [Table: see text]
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Affiliation(s)
| | - Boglarka Gyurkocza
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Davis
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Flynn
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Sean Quach
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Cho
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Fingrut W, Davis E, Chinapen S, Naputo K, Hoover E, Scaradavou A, Giralt SA, Perales MA, Politikos I, Barker JN. Inaccuracies in Assignment of Patient Race & Ethnicity Highlights the Necessity of Staff Training to Accurately Capture Ancestry: Implications for Alternative Donor Allografts & Cancer Care Delivery. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00588-7] [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: 11/16/2022]
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Politikos I, Flynn J, Devlin SM, Fingrut W, Maloy MA, Naputo K, Chinapen S, Rodriguez NT, Quach S, Dominguez Y, Scaradavou A, Roshal M, Cho C, Dahi PB, Gyurkocza B, Jakubowski AA, Papadopoulos EB, Ponce DM, Sauter CS, Shaffer BC, Tamari R, Scordo M, Young J, Giralt SA, Perales MA, Barker JN. Double Unit Cord Blood Transplantation Compares Favorably to T-Cell Depleted Matched Adult Donor Transplantation for the Treatment of Acute Leukemia Due to a Robust Protection Against Relapse. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Politikos I, Lau C, Devlin SM, Naputo K, Quach S, Chinapen S, Lin A, Papadopoulos EB, Perales MA, Shah G, Seo SK, Papanicolaou GA, Barker JN. Extended Letermovir Prophylaxis Is Highly Effective Cytomegalovirus (CMV) Infection Prevention in Adult Cord Blood Transplantation (CBT) Recipients & Does Not Prevent Emergence of CMV-Specific Donor-Derived Immunity. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00629-7] [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: 11/16/2022]
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Jimenez Jimenez AM, Perales MA, Devlin SM, Brown S, Lekakis LJ, Sauter CS, Pereira D, Wang TP, Ponce DM, Beitinjaneh A, Chinapen S, Goodman M, Komanduri KV, Shaffer BC. Post-Transplant Cyclophosphamide (PTCy) Is Associated with Superior Gvhd-Free, Relapse-Free Survival (GRFS) in HLA-Mismatched Unrelated Donor (MMUD) Hematopoietic Cell Transplantation. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Preston EV, Chinapen S, Borrill T, Davis E, Shaffer BC, Tamari R, Jakubowski AA, Perales MA, Ponce DM, Shah GL, Dahi PB, Barker JN, Berman E, Tallman M, Giralt SA, Stein E, Gyurkocza B. Disease Progression is Main Barrier to Allogeneic Hematopoietic Stem Cell Transplantation (HCT) in Patients with Newly Diagnosed and Relapsed Acute Leukemia. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.378] [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]
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Hernández CJ, Ortíz T, Rosa C, Foster K, Tyagi M, Lugo N, Albrecht R, Chinapen S. Substance P and acetylcholine are co-localized in the pathway mediating mucociliary activity in Rana pipiens. Comp Biochem Physiol B Biochem Mol Biol 2007; 146:477-81. [PMID: 17276713 PMCID: PMC1876671 DOI: 10.1016/j.cbpb.2006.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 11/10/2006] [Accepted: 11/11/2006] [Indexed: 10/23/2022]
Abstract
Mucociliary activity is an important clearance mechanism in the respiratory system of air breathing vertebrates. Substance P (SP) and acetylcholine play a key role in the stimulation of the mucociliary transport in the frog palate. In this study, retrograde neuronal tracing was combined with immunocytochemistry for SP and choline acetyl transferase (ChAT) in the trigeminal ganglion and for neurokinin-1 receptor (NK1R) in the palate of Rana pipiens. The cells of origin of the palatine nerve were identified in the trigeminal ganglion using the retrograde tracer Fluorogold (FG). Optimal labeling of FG cells in the trigeminal ganglion was obtained at 96 h of exposure. Immunoflorescent shows that SP and acetylcholine are co-localized in 92% of the cells labeled with FG in the trigeminal ganglion. NK1 receptors were found in the membrane of epithelial and goblet cells of the palate. Ultrastructural study of the palate showed axonal-like endings with vesicles in connection with epithelial and goblet cells. These results further support the concerted action of both neurotransmitters in the regulation of mucociliary activity in the frog palate.
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Affiliation(s)
- C J Hernández
- Department of Biology, University of Puerto Rico at Humacao, Humacao 00791, Puerto Rico.
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Hernández CJ, Berríos A, Chinapen S. Localization of substance P-like immunoreactivity in the palate and trigeminal ganglion of Rana pipiens. Comp Biochem Physiol C Toxicol Pharmacol 2003; 134:465-72. [PMID: 12727296 DOI: 10.1016/s1532-0456(03)00025-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study was undertaken to localize substance P-like immunoreactivity (SP) in the nerve fibers innervating the palate, identify the ganglion of the palatine nerve and determine whether it contains SP cell bodies, in the frog Rana pipiens. The palatine nerve which is a branch of the maxillo-mandibular subdivision of the trigeminal nerve was traced to the trigeminal ganglion that connects to the medulla by the trigeminal nerve root. Using an immunocytochemical method, SP containing fibers with varicosities were found in the connective tissue layer of the palate. Some of these fibers were observed adjacent to blood vessels to the epithelial layer of the palate in apparent innervation of the ciliated epithelial and mucus cells. SP-labeling was also observed in small to medium cells of the trigeminal ganglion. These results appear to support the pharmacological studies of SP on the regulation of mucociliary activity in the frog R. pipiens.
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Affiliation(s)
- C J Hernández
- Department of Biology, University of Puerto Rico, Humacao Campus, CUH Station, Humacao 00791, Puerto Rico.
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Komisaruk BR, Rosenblatt JS, Barona ML, Chinapen S, Nissanov J, O'Bannon RT, Johnson BM, Del Cerro MC. Combined c-fos and 14C-2-deoxyglucose method to differentiate site-specific excitation from disinhibition: analysis of maternal behavior in the rat. Brain Res 2000; 859:262-72. [PMID: 10719073 DOI: 10.1016/s0006-8993(00)01972-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
On the basis of evidence that 14C-2-deoxyglucose (2-DG) autoradiography indicates activity at axonal terminals, whereas c-fos immunocytochemistry indicates activity of neuronal cell bodies, we combined these techniques in adjacent histological brain sections to assess excitatory and disinhibitory synaptic relations in selected sites in female rats in which maternal behavior was elicited by natural parturition, sensitization (7- to 10-day cohabitation with foster pups), or hysterectomy. All individuals in these three groups expressed maternal behavior immediately before 2-DG injection. Controls were non-maternal virgins. Parturient and Hysterectomized groups: elevation (compared with controls) in both 2-DG and c-fos activity in medial preoptic area (MPOA) indicated an increase in its input and output activity, i.e., an excitatory interaction; the MPOA was previously shown to be critical for maternal behavior. Sensitized group: a decrease in 2-DG activity of vomeronasal nuclei (bed nucleus of the accessory olfactory tract, BAOT, and medial amygdala, ME, replicating our previous study) and an elevation in c-fos activity, jointly indicate disinhibition of these nuclei, that were previously shown to modulate pup-chemostimulation-induced sensitization. All other sites showed evidence of excitatory input-output relationships (i.e., joint increase in both 2-DG and c-fos activity), e.g., bed nucleus of the stria terminalis (BNST), lateral habenula (LHAB), central gray (CG), thalamus (THAL), septum (SEPT), and ventral tegmental area (VTA). The present study demonstrates the feasibility of measuring 2-DG and c-fos activity jointly in adjacent sections of the same brain, thereby providing evidence to distinguish between localized excitation and disinhibition.
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Affiliation(s)
- B R Komisaruk
- Department of Psychology, The State University of New Jersey, 101 Warren Street, Rutgers, Newark, NJ, USA.
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Chinapen S, Swann JM, Steinman JL, Komisaruk BR. Expression of c-fos protein in lumbosacral spinal cord in response to vaginocervical stimulation in rats. Neurosci Lett 1992; 145:93-6. [PMID: 1461575 DOI: 10.1016/0304-3940(92)90211-o] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The pattern of vaginocervical stimulation-evoked expression of the proto-oncogene c-fos in lumbar 5-sacral 1 segments of the spinal cord of ovariectomized adult rats was mapped using immunocytochemistry. A calibrated force of mechanostimulation was applied to the vaginal cervix of experimental animals and to the perineum of control animals while they were gently restrained. The number of cells expressing c-fos was significantly greater in the experimental than the control animals in laminae I, IV, V-VI and X. The implications of the present findings for elucidating the spinal pathways mediating the various behavioral, neuroendocrine and autonomic effects of vaginocervical stimulation (VS) are discussed.
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Affiliation(s)
- S Chinapen
- Institute of Animal Behavior, Rutgers University, Newark, NJ 07102
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