29 results on '"Allison Rosenthal"'
Search Results
2. Evaluating the Patient with Neurotoxicity after Chimeric Antigen Receptor T-cell Therapy
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Shannon P. Fortin Ensign, Charles Gaulin, Maya Hrachova, Michael Ruff, Ehab Harahsheh, Kevin Vicenti, Januario Castro, Javier Munoz, Allison Rosenthal, and Maciej M. Mrugala
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Receptors, Chimeric Antigen ,Oncology ,T-Lymphocytes ,Receptors, Antigen, T-Cell ,Cell- and Tissue-Based Therapy ,Humans ,Pharmacology (medical) ,Immunotherapy, Adoptive - Abstract
Chimeric antigen receptor (CAR) T-cells are now a well-established treatment for hematologic malignancies. Their use in clinical practice has expanded quite rapidly and hospitals have developed CAR T-cell protocols to evaluate patients for associated toxicities, and particularly for neurotoxicity. There are many variables that influence the risk for developing this complication, many of which are not fully understood. The severity can be related to a particular product. Clinical vigilance is critical to facilitate early recognition of neurotoxicity, hence the importance of pre-CAR T-cell neurological evaluation of each patient. While details of such an evaluation may slightly differ between institutions, generally a comprehensive neurological evaluation including assessment of cognitive abilities along with magnetic resonance imaging (MRI) of the brain is a gold standard. Management of neurotoxicity requires a well-orchestrated team approach with specialists from oncology, neurology, oftentimes neurosurgery and neuro-intensive care. Diagnostic work-up frequently includes detailed neurologic evaluation with comparison to the baseline assessment, imaging of the brain, electroencephalogram, and lumbar puncture. While steroids are uniformly used for treatment, many patients also receive tocilizumab for an underlying and frequently concomitant cytokine release syndrome (CRS) in addition to symptom-driven supportive care. Novel CAR T-cell constructs and other agents allowing for potentially lower risk of toxicity are being explored. While neurotoxicity is predominantly an early, and reversible, event, a growing body of literature suggests that late neurotoxicity with variable clinical presentation can also occur.
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- 2022
3. Supportive Care for Patients with Lymphoma Undergoing CAR-T-cell Therapy: the Advanced Practice Provider’s Perspective
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Ginna Granroth, Allison Rosenthal, Maggie McCallen, Christopher Coughlin, Hollie Benson, Jeanne Palmer, Januario E. Castro, and Javier Munoz
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Receptors, Chimeric Antigen ,Lymphoma ,Oncology ,Hematologic Neoplasms ,Antigens, CD19 ,Receptors, Antigen, T-Cell ,Cell- and Tissue-Based Therapy ,Humans ,Immunotherapy, Adoptive - Abstract
The purpose of our paper is to describe the all-encompassing supportive care for patients with relapsed or refractory lymphoma undergoing cellular therapy, with a focus on the advanced practice provider's (APPs) perspective.Chimeric antigen receptor-T (CAR-T) cell therapy has become more available for treating relapsed or refractory B-cell hematologic malignancies, requiring proficient and adequate treatment of side effects, complications, and infections that may occur during therapy. APPs often meet these patients during the initial referral and help to support them through the CAR-T cell therapy process. As APPs acquire a complete understanding and comprehensive knowledge of how to treat, support, and guide patients with B-cell malignancies through CAR-T cell therapy, they play a pivotal role in these patients throughout their treatment. Standardization of supportive care is paramount.
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- 2022
4. Next-generation ALK inhibitors are highly active in ALK-positive large B-cell lymphoma
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Jacob D. Soumerai, Allison Rosenthal, Shannon Harkins, Jessica Duffy, Carmen Mecca, Yingbing Wang, Ravinder K. Grewal, Areej R. El-Jawahri, Huiyun Liu, Cedric Menard, Ahmet Dogan, Lei Yang, Lisa M. Rimsza, Kurt Bantilan, Haley Martin, Matthew Lei, Sydney Mohr, Anna Kurilovich, Olga Kudryashova, Ekaterina Postovalova, Valentina Nardi, Jeremy S. Abramson, Roberto Chiarle, Andrew D. Zelenetz, and Abner Louissaint
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Lymphoma, B-Cell ,Lung Neoplasms ,Immunology ,Humans ,Anaplastic Lymphoma Kinase ,Cell Biology ,Hematology ,Protein Kinase Inhibitors ,Biochemistry - Published
- 2022
5. Progression-Free Survival at 24 Months as A Landmark After Autologous Stem Cell Transplant in Relapsed or Refractory Diffuse Large B-cell Lymphoma
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Aung M. Tun, Seth Maliske, Yucai Wang, David J. Inwards, Thomas M. Habermann, Ivana Micallef, Luis Porrata, Jonas Paludo, Jose Villasboas Bisneto, Allison Rosenthal, Mohamed A Kharfan-Dabaja, Stephen M. Ansell, Grzegorz S. Nowakowski, Umar Farooq, and Patrick B. Johnston
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Adult ,Male ,Transplantation ,Lymphoma, Non-Hodgkin ,Hematopoietic Stem Cell Transplantation ,Cell Biology ,Hematology ,Middle Aged ,Transplantation, Autologous ,Progression-Free Survival ,Young Adult ,Humans ,Molecular Medicine ,Immunology and Allergy ,Female ,Lymphoma, Large B-Cell, Diffuse ,Neoplasm Recurrence, Local ,Aged - Abstract
Patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who achieve progression-free survival (PFS) at 24 months (PFS24) after immunochemotherapy (IC) have excellent overall survival (OS) comparable to that of the age- and sex-matched general population. However, a similar landmark has not been established for patients with relapsed or refractory (RR) DLBCL following frontline IC who are subsequently treated with salvage therapy followed by autologous stem cell transplantation (ASCT). To evaluate the role of PFS24 as a landmark after ASCT in patients with RR DLBCL, we identified patients with RR DLBCL after frontline R-CHOP or R-CHOP-like IC who underwent salvage therapy and ASCT at Mayo Clinic between July 2000 and December 2017 and University of Iowa between April 2003 and April 2020 from institutional lymphoma and transplantation databases. Clinical characteristics, treatment information, and outcome data were abstracted. PFS, OS, and post-ASCT relapse survival (PRS) were analyzed using Kaplan-Meier method, and cumulative incidences of relapse versus nonrelapse mortality and different causes of death were compared accounting for competing events. A total of 437 patients were identified. Median age at ASCT was 61 years (range 19-78), and 280 (64%) were male. After a median post-ASCT follow-up of 8.0 years (95% confidence interval [CI], 7.2-8.7), 215 patients had a relapse (or disease progression), 180 within 2 years and 35 after 2 years. For the entire cohort, the post-ASCT relapse rate was much higher than the nonrelapse mortality rate (48.1% versus 9.1% at 5 years). Median PFS and OS after ASCT was 2.7 and 5.4 years, respectively. Lymphoma was the primary cause of death after ASCT. In contrast, for patients who had achieved PFS24 (n = 220), rates of post-PFS24 relapse and nonrelapse mortality were similar (14.8% and 12.3% at 5 years). Median PFS and OS after achieving PFS24 was 10.0 and 11.5 years, respectively. Lymphoma-related and -unrelated death rates were similar after achieving PFS24. For all patients who had a post-ASCT relapse, median PRS was 0.7 (95% CI, 0.5-0.9) year, and late relapse (2 versus ≤2 years after ASCT) was associated with better PRS (median 2.3 [1.7-4.8] versus 0.5 [0.3-0.7] years, P.001). The study establishes PFS24 as an important landmark associated with post-ASCT outcomes in patients with RR DLBCL after frontline IC.
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- 2022
6. Leukemic High Grade B Cell Lymphoma is Associated With MYC Translocation, Double Hit/Triple Hit Status, Transformation, and CNS Disease Risk: The Mayo Clinic Experience
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Justin J. Kuhlman, Muhamad Alhaj Moustafa, Liuyan Jiang, Madiha Iqbal, Karan Seegobin, Zoe Wolcott, Ernesto Ayala, Steve Ansell, Allison Rosenthal, Jonas Paludo, Ivana Micallef, Patrick Johnston, David Inwards, Thomas Habermann, Mohamed Kharfan-Dabaja, Thomas E. Witzig, Grzegorz S. Nowakowski, and Han W. Tun
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Proto-Oncogene Proteins c-myc ,Cancer Research ,Proto-Oncogene Proteins c-bcl-2 ,Oncology ,Central Nervous System Diseases ,Proto-Oncogene Proteins c-bcl-6 ,Humans ,Disease Susceptibility ,Lymphoma, Large B-Cell, Diffuse ,Hematology ,Burkitt Lymphoma ,Translocation, Genetic - Abstract
Leukemic involvement in high grade B cell lymphoma (L-HGBL) is rare and has been sparsely described in the literature. We report our experience in a large single institution multicenter academic setting.Medical records of patients with HGBL who received care at Mayo Clinic between 2003 and 2020 were reviewed. L-HGBL was confirmed by peripheral blood smear and flow cytometry with corroboration from tissue and bone marrow biopsy findings.Twenty patients met inclusion criteria. All patients had significant bone marrow involvement by HGBL. Leukemic involvement presented in 11 of 20 (55%) in the de novo and 9 of 20 (45%) in the relapsed setting. Seven of 20 patients had DLBCL, NOS, 6 of 20 had transformation (t-DLBCL), 3 of 20 had transformed double/triple hit lymphoma (t-DHL/THL), 2 of 20 had double hit lymphoma (DHL), and 2 of 20 had HGBL with intermediate features between DLBCL and Burkitt lymphoma. Nine of 15 patients had MYC translocation. Based on Hans criteria, 11 of 20 had germinal center B-cell (GCB) cell of origin (COO) and 9/20 had non-GCB COO. Five of 11 de novo patients experienced CNS relapse/progression. All de novo patients received anthracycline-based chemoimmunotherapy. Eighteen of 20 patients died of progressive disease. Median overall survival was significantly better in the de novo compared to relapsed group (8.9 months vs. 2.8 months, P = .01). COO, MYC status, DHL/THL status, HGBL subtype, or treatment group did not demonstrate a significant effect on overall survival.L-HGBL carries a poor prognosis and is associated with MYC translocation, DHL/THL status, transformation, and high CNS risk. Novel therapeutic approaches are needed for L-HGBL.
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- 2022
7. Low Incidence of Fungal Infections after Chimeric Antigen Receptor T-Cell Therapy for Non-Hodgkin Lymphoma in an Endemic Region for Coccidioidomycosis
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Charles Gaulin, Matthew L. Ulrickson, Muhammad Husnain, Madiha Iqbal, Paschalis Vergidis, Allison Rosenthal, Hemant Murthy, Carolyn Mead-Harvey, Yucai Wang, Januario E. Castro, Jeanne Palmer, Jose F. Leis, Patrick B. Johnston, Janis Blair, Mohamed A. Kharfan-Dabaja, Yi Lin, and Javier Muñoz
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Transplantation ,Immunology ,Molecular Medicine ,Immunology and Allergy ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
8. Incidence of thrombosis in relapsed/refractory B-cell lymphoma treated with axicabtagene ciloleucel: Mayo Clinic experience
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Megan Melody, Sangeetha Gandhi, Hollie Saunders, Zaid Abdel-Rahman, Jacquelyn Hastings, Paula Lengerke Diaz, Nicole Gannon, Tuan Truong, Matthew Hathcock, Arushi Khurana, Patrick Johnston, Stephen Ansell, Nora Bennani, Jonas Paludo, Jose Villasboas Bisneto, Yucai Wang, Allison Rosenthal, James Foran, Ernesto Ayala, Hemant S. Murthy, Vivek Roy, Januario E. Castro, Yi Lin, and Mohamed A. Kharfan-Dabaja
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Biological Products ,Cancer Research ,Oncology ,Incidence ,Antigens, CD19 ,Humans ,Thrombosis ,Lymphoma, Large B-Cell, Diffuse ,Venous Thromboembolism ,Hematology ,Immunotherapy, Adoptive ,Retrospective Studies - Abstract
Chimeric antigen receptor (CAR) T-cell therapy is effective in relapsed/refractory large B-cell lymphoma and results in a unique toxicity profile, namely cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome. The hyper-inflammatory state associated with these toxicities has been suggested to increase the risk of thrombosis. We conducted a retrospective analysis of patients treated with axicabtagene ciloleucel (axi-cel) to assess the rate of thrombosis with axi-cel therapy from the time of CAR T-cell infusion until the end of hospitalization, when performed in the inpatient setting, or up to day +30 when performed in the outpatient setting. Ninety-two (95%) of 97 patients were hospitalized during axi-cel therapy and 85 (88%) developed CRS. Fifty-five patients (57%) received concurrent anticoagulation (53 as prophylaxis). Patients with prior VTE did not have progression or evidence of new VTE. Only 2 (2.1%) patients developed VTE. These results demonstrate a low-risk for thrombosis in axi-cel recipients.
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- 2022
9. Does bridging radiation therapy affect the pattern of failure after CAR T-cell therapy in non-Hodgkin lymphoma?
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Omran Saifi, William G. Breen, Scott C. Lester, William G. Rule, Bradley Stish, Allison Rosenthal, Javier Munoz, Steven M. Herchko, Hemant S. Murthy, Yi Lin, Radhika Bansal, Matthew A. Hathcock, N. Nora Bennani, Jonas Paludo, Yucai Wang, Arushi Khurana, Jose C. Villasboas Bisneto, Patrick B. Johnston, Stephen M. Ansell, Madiha Iqbal, Han Tun, Ernesto Ayala, Mohamed A. Kharfan-Dabaja, Bradford S. Hoppe, and Jennifer L. Peterson
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Oncology ,Lymphoma, Non-Hodgkin ,Humans ,Radiotherapy Dosage ,Radiology, Nuclear Medicine and imaging ,Hematology ,Immunotherapy, Adoptive ,Retrospective Studies - Abstract
Analyze the pattern of disease failure after anti-CD19-directed chimeric antigen receptor T-cell therapy (CART) for non-Hodgkin lymphoma, assess the local control rate of bridging radiotherapy (bRT) and characterize in-field recurrences.We retrospectively reviewed 120 patients with NHL who received CART between 2018 and 2020. Baseline characteristics and treatment outcomes were compared between patients who received bRT and those who did not (noRT).Of the 118 patients included, 14 (12%) received bRT, while 104 (88%) did not. bRT group had more localized and extranodal disease. bRT was delivered with a median dose of 20 Gy (range: 15-36) in 5 fractions (range: 3-24). Pattern of failure analysis revealed that progression involving pre-existing sites was the predominant pattern of failure in both the bRT and noRT groups (86% and 88%, respectively). Median duration of response was 128 days (range: 25-547) for bRT group and 93 days (range: 22-965) for noRT group (p = 0.78). In the bRT group, only 2/15 sites irradiated had infield recurrence and where characterized by bulky disease, SUVMajority of progressions after CART infusion involve pre-existing sites. Bridging RT prior to CART provides excellent in-field local control and durable response. Patients with bulky disease, SUV
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- 2022
10. Don't put the CART before the horse: The role of radiation therapy in peri-CAR T-cell therapy for aggressive B-cell non-Hodgkin lymphoma
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Omran Saifi, William G. Breen, Scott C. Lester, William G. Rule, Bradley J. Stish, Allison Rosenthal, Javier Munoz, Yi Lin, Radhika Bansal, Matthew A. Hathcock, N. Nora Bennani, Jonas Paludo, Arushi Khurana, Jose C. Villasboas, Patrick B. Johnston, Stephen M. Ansell, Madiha Iqbal, Muhamad Alhaj Moustafa, Hemant S. Murthy, Mohamed A. Kharfan-Dabaja, Bradford S. Hoppe, and Jennifer L. Peterson
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Cancer Research ,Radiation ,Oncology ,Radiology, Nuclear Medicine and imaging - Abstract
The optimal approach to incorporate radiotherapy (RT) in conjunction with CAR T-cell Therapy (CART) for relapsed/refractory (r/r) B-cell non-Hodgkin lymphoma (bNHL) remains unclear. This study documents the RT local control rate among patients who received bridging radiotherapy (BRT) prior to CART and compares it to those who received salvage radiotherapy (SRT) post CART. It further reports on a promising way to utilize SRT for post CART disease, and identifies predictors for RT in-field recurrence.We retrospectively reviewed 83 patients with r/r bNHL who received CART and RT, either as BRT pre-CART infusion (n=35) or as SRT post-CART infusion (n=48), between 2018 and 2021. RT was defined as comprehensive (compRT) - treated all sites of active disease - or focal (focRT). Limited disease was defined as disease amenable to compRT, involving5 active disease sites.At time of RT, patients who received BRT prior to CART had bulkier disease sites (median diameter 8.7cm vs. 5.5cm; p=0.01) and were treated to significantly lower doses (median equivalent 2 Gy dose 23.3Gy vs. 34.5Gy, p=0.002), compared to SRT post CART. Among 124 total irradiated sites identified, 8/59 (13%) bridged-sites and 21/65 (32%) salvaged-sites experienced in-field recurrence translating to 1-year local control rate (LC) of 84% and 62%, respectively (p=0.009). Patients with limited post-CART disease (n=37) who received compSRT (n=26) had better overall survival (51% vs. 12%; p=0.028), freedom from subsequent progression (31% vs. 0%; p0.001) and freedom from subsequent event (19% vs. 0%; p=0.011) compared to patients with limited disease who received focSRT (n=11).BRT followed by CART appears to be associated with improved LC compared to SRT in r/r bNHL. Nonetheless, SRT offers a promising salvage intervention for limited (5 sites) relapsed post-CART disease if given comprehensively.
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- 2022
11. CTIM-34. PRELIMINARY SAFETY AND EFFICACY DATA ON TWO PATIENTS WITH RELAPSED/REFRACTORY CNS LYMPHOMA TREATED WITH EMAVUSERTIB (CA-4948) AND IBRUTINIB COMBINATION: A SUBSET ANALYSIS OF TAKEAIM LYMPHOMA TRIAL
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Madiha Iqbal, Han Tun, Erel Joffe, Christian Grommes, Grzegorz Nowakowski, Matthew Lunning, Radhakrishnan Ramchandren, Chia-Cheng Li, Wanying Zhao, Elizabeth Martinez, Reinhard von Roemeling, Robert Earhart, Meaghan McMahon, Iris Isufi, Lori Leslie, and Allison Rosenthal
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Cancer Research ,Oncology ,Neurology (clinical) - Abstract
BACKGROUND Emavusertib, an oral interleukin-1 receptor-associated kinase 4 (IRAK4) inhibitor, targets toll-like receptor (TLR) and interleukin-1 receptor (IL-1R) signaling pathway in B-cell proliferation. IRAK4 forms a Myddosome complex with MYD88 adaptor protein and drives overactivation of NF-κB, causing inflammation and tumor growth. Emavusertib has been reported to be well tolerated and active as monotherapy in heavily pretreated relapsed/refractory (R/R) non-Hodgkin lymphoma (NHL). In a murine PDX model of primary CNS lymphoma (PCNSL), emavusertib crossed the blood-brain barrier, resulting in tumor response and prolonged survival. In combination with Bruton tyrosine kinase (BTK) inhibitors, emavusertib showed in vivo anti-cancer synergy in B-cell NHL. METHODS This is an ongoing open-label trial (NCT03328078) in patients with R/R NHL. Currently, we are in the dose escalation portion of combination therapy to evaluate safety and efficacy following treatment of emavusertib at dose levels of 200 or 300mg BID with ibrutinib at full prescribed dose. As of May 6th, 2022, 13 patients have been treated with emavusertib+ibrutinib combination therapy. RESULTS Among the 13 patients, two were diagnosed with R/R PCNSL and had several prior lines of anti-cancer therapy. Emavusertib in combination with ibrutinib (560 mg daily) appeared to be well tolerated in these two subjects. One patient experienced Gr3 treatment-related adverse events (thrombocytopenia, muscle weakness, pain). The preliminary efficacy data demonstrated one CR and one SD. The patient who achieved CR after the combination therapy was originally intolerant to high-dose methotrexate based chemoimmunotherapy and did not achieve complete remission after switching to ibrutinib, providing early clinical evidence of CNS penetration and anti-tumor activity of emavusertib. CONCLUSION In R/R PCNSL, these preliminary data suggest that combination therapy has a tolerable safety profile with promising anti-cancer activity and may overcome ibrutinib resistance.
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- 2022
12. Clinical and therapeutic implications of BRAF fusions in histiocytic disorders
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Saurabh Zanwar, Jithma P. Abeykoon, Surendra Dasari, Aishwarya Ravindran, Jason R. Young, Aldo A. Acosta-Medina, Karen L. Rech, Jonathan Schwartz, Aaron Mangold, Allison Rosenthal, N. Nora Bennani, Mithun V. Shah, Diana Morlote, Gaurav Goyal, and Ronald S. Go
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Proto-Oncogene Proteins B-raf ,Oncology ,Mutation ,Humans ,Hematology ,Protein Kinase Inhibitors - Published
- 2022
13. Impact of Rituximab and Corticosteroids on Late Cytopenias Post-Chimeric Antigen Receptor T Cell Therapy
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Madiha Iqbal, Radhika Bansal, Farah Yassine, Sangeetha Gandhi, Allison Rosenthal, Muhamad Alhaj Moustafa, Zhuo Li, Emily C. Craver, Razan Mohty, Hemant Murthy, Ernesto Ayala, Han Tun, Javier Munoz, Januario Castro, Yi Lin, and Mohamed A. Kharfan-Dabaja
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Transplantation ,Receptors, Chimeric Antigen ,Antigens, CD19 ,Hematopoietic Stem Cell Transplantation ,Anemia ,Cell Biology ,Hematology ,Immunotherapy, Adoptive ,Thrombocytopenia ,Adrenal Cortex Hormones ,Lymphopenia ,Molecular Medicine ,Immunology and Allergy ,Humans ,Neoplasm Recurrence, Local ,Rituximab - Abstract
Chimeric antigen receptor (CAR) T cell therapy represents a significant advancement in the treatment of patients with relapsed/refractory B cell lymphoid malignancies. Cytokine release syndrome and immune effector cell-associated neurotoxicity represent the most acute serious adverse events post CAR T cell therapy but the occurrence and persistence of cytopenias post CAR T cell therapy represent a significant adverse event and a management challenge. While most patients typically recover blood counts by 30 days, a significant subset of patients have persistent or late cytopenias beyond 30 days. Patients receiving CAR T cell are heavily pre-treated and the impact of prior therapies on late cytopenias is not well understood. In this study, we found an association between increased number of rituximab infusions and/or cumulative rituximab dose received prior to CAR T cell infusion and persistent anemia and thrombocytopenia at 90 and 180 days afterwards. An overall increased number of prior lines of therapy was also associated with persistent lymphopenia and anemia at 90 days while receiving a prior autologous hematopoietic cell transplant was associated with a greater risk of neutropenia and lymphopenia.
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- 2022
14. Outcomes of Patients With Classic Hodgkin Lymphoma Who Relapsed After Autologous Stem Cell Transplant
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Aung M. Tun, Yucai Wang, Aasiya Matin, David J. Inwards, Thomas M. Habermann, Ivana Micallef, Patrick B. Johnston, Luis Porrata, Jonas Paludo, Jose Villasboas Bisneto, Allison Rosenthal, Han W. Tun, James R. Cerhan, Thomas E. Witzig, Grzegorz S. Nowakowski, and Stephen M. Ansell
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Hematology - Published
- 2023
15. Acute seizures and status epilepticus in immune effector cell associated neurotoxicity syndrome (ICANS)
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Jacqui-Lyn Saw, M. Hasib Sidiqi, Michael Ruff, Sara Hocker, Hassan Alkhateeb, Stephen M. Ansell, N. Nora Bennani, David Dingli, Suzanne R. Hayman, Patrick B. Johnston, Prashant Kapoor, Saad J. Kenderian, Taxiarchis V. Kourelis, Shaji K. Kumar, Jonas Paludo, Mithun V. Shah, Mustaqeem A. Siddiqui, Rahma Warsame, Allison Rosenthal, Marie Grill, Januario E. Castro, Jason Siegel, Zaid H. Abdel Rahman, Mohamed A. Kharfan-Dabaja, Elson So, and Yi Lin
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Status Epilepticus ,Oncology ,Seizures ,Humans ,Neurotoxicity Syndromes ,Hematology - Published
- 2022
16. Quality of Life and Survivorship in Lymphoma
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Allison Rosenthal
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Oncology ,Lymphoma ,Quality of Life ,Humans ,Patient Reported Outcome Measures ,Prospective Studies ,Survivorship - Abstract
With an increasing number of long-term lymphoma survivors, there has been emphasis on optimizing quality of life and identifying survivorship challenges. This review summarizes the latest advancements pertaining to health-related quality of life and survivorship in lymphoma.Quality of life can vary from diagnosis through survivorship though some physical, social, and emotional effects may be persistent. Incorporation of patient reported outcomes enables recognition of factors that significantly impact quality of life. A greater understanding of quality of life and survivorship issues has generated momentum for practice change, improving education, and designing behavior related interventions. Patients with lymphoma face many challenges as they navigate their cancer experience. There is a tremendous opportunity to build upon this work through well-designed prospective longitudinal studies aimed at identifying vulnerable patient groups and impactful points of intervention during survivorship.
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- 2022
17. A real-world study of combined modality therapy for early-stage Hodgkin lymphoma: too little treatment impacts outcome
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Karan L. Chohan, Jason R. Young, Scott Lester, Muhamad Alhaj Moustafa, Allison Rosenthal, Han W. Tun, Bradford S. Hoppe, Patrick B. Johnston, Ivana N. Micallef, Thomas M. Habermann, and Stephen M. Ansell
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Cohort Studies ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Hematology ,Combined Modality Therapy ,Hodgkin Disease ,Retrospective Studies - Abstract
Multiple clinical trials have assessed de-escalation strategies from combined modality therapy (CMT) to chemotherapy-alone for the treatment of early-stage classical Hodgkin lymphoma (cHL), confirming similar outcomes. The application of these data to the real-world is limited, however. We conducted a retrospective, multicenter cohort study comparing CMT vs chemotherapy-alone in patients with early-stage cHL (stage IA-IIB) treated between January 2010 and December 2020. Positron emission tomography (PET) scans after chemotherapy cycle 2 (PET2) were independently reviewed by a nuclear radiologist (Deauville score ≥4, positive; ≤3, negative). Patient outcomes were compared by using an intention-to-treat analysis. Among 125 patients (CMT, n = 63; chemotherapy-alone, n = 62) with a median follow-up of 59.8 months (95% CI, 48.6-71.0), no differences in overall survival were observed (5-year overall survival, CMT 98.0% vs chemotherapy-alone 95.1%; log-rank test, P = .38). However, there was reduced progression-free survival (PFS) with chemotherapy-alone among all patients (2-year PFS, CMT 95.1% vs chemotherapy-alone 75.3%; log-rank test, P = .005) and in those with bulky (n = 43; log-rank test, P < .001), unfavorable (n = 81; log-rank test, P = .002), or PET2-positive (n = 15; log-rank test, P = .02) disease. No significant differences in PFS were seen for patients with non-bulky (log-rank test, P = .35), favorable (log-rank test, P = .62), or PET2-negative (log-rank test, P = .19) disease. Based on our real-world experience, CMT seems beneficial for patients with early-stage cHL, especially those with PET2-positive and unfavorable disease. Chemotherapy-alone regimens can lead to comparable outcomes for patients with favorable, non-bulky, or PET2-negative disease. We conclude that although results seen in clinical trials are replicated in certain patient subgroups, other subgroups not fitting trial criteria do poorly when radiotherapy is excluded.
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- 2022
18. Radiation and Chimeric Antigen Receptor T-cell Therapy in B-cell Non-Hodgkin Lymphomas
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Anagha Deshpande, William Rule, and Allison Rosenthal
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Lymphoma, B-Cell ,Receptors, Chimeric Antigen ,Oncology ,Lymphoma ,Cell- and Tissue-Based Therapy ,Receptors, Antigen, T-Cell ,Humans ,Pharmacology (medical) ,Prospective Studies ,Immunotherapy, Adoptive - Abstract
Chimeric antigen receptor T-cell therapy (CAR-T) is a revolutionary advancement in the management of chemotherapy refractory B-cell non-Hodgkin lymphomas representing a potentially curative therapy in scenarios that were previously only palliative. CAR-T cell therapy is associated with unique toxicities as well as practical challenges. One of those challenges is how to manage active lymphoma during the weeks-long CAR-T manufacturing process. Radiation therapy, steroids, and systemic therapy have all been used for what would be considered "bridging therapy" during this time frame. Radiation therapy is a particularly attractive strategy given its proven efficacy in chemotherapy refractory lymphomas; ability to stabilize patients, debulk disease, and palliate symptoms; as well as its potential to enhance the expansion and activity of CAR-T cells. Optimal dose, timing, and method of delivery are yet to be established though there is consensus that it should occur after apheresis if being used as a pre-treatment bridge. Another practical challenge is the management of patients in whom CAR-T cells fail. There is a potential emerging role for salvage radiation therapy, in select patients, for either palliation or as a means to get patients another potentially curative therapy. Collaborative well-designed prospective clinical trials are needed to definitively establish the role for radiation therapy (before or after CAR-T therapy) as well as define the impact on CAR-T cell activity/persistence and associated toxicity.
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- 2021
19. 32888 Primary cutaneous B-cell lymphoma treated with systemic rituximab
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Jake Besch-Stokes, Puneet Bhullar, Pranav Puri, Blake Boudreaux, Collin Costello, William Rule, Allison Rosenthal, David J. DiCaudo, Mark R. Pittelkow, and Aaron Mangold
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Dermatology - Published
- 2022
20. 32922 Intralesional rituximab for indolent primary cutaneous B-cell lymphoma
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Jake Besch-Stokes, Puneet Bhullar, Pranav Puri, Blake Boudreaux, Collin Costello, William Rule, Allison Rosenthal, David J. DiCaudo, Mark R. Pittelkow, and Aaron Mangold
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Dermatology - Published
- 2022
21. An Updated Multi-Center Retrospective Study of Polatuzumab for Patients with Large B-Cell Lymphoma Relapsed after Standard of Care CAR T-Cell Therapy
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Paolo Strati, Allison Rosenthal, Sushanth Gouni, Jennifer Crombie, Andrew Ip, Manali Kamdar, Brian Hess, Lei Feng, Grace Watson, Amy Ayers, Arushi Khurana, Madiha Iqbal, Yi Lin, Reid Merryman, and Sattva S. Neelapu
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Transplantation ,Molecular Medicine ,Immunology and Allergy ,Cell Biology ,Hematology - Published
- 2022
22. Hemophagocytic Lymphohistiocytosis/Macrophage Activation Syndrome Associated with Chimeric Antigen Receptor T-Cell Therapy: Clinical Presentations, Outcomes and Management
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Arushi Khurana, Allison Rosenthal, Radhika Bansal, Matthew Hathcock, Adrienne Nedved, Yucai Wang, Jonas Paludo, Jose C Villasboas, Nora N Bennani, Patrick B Johnston, Stephen Ansell, and Yi Lin
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Transplantation ,Molecular Medicine ,Immunology and Allergy ,Cell Biology ,Hematology - Published
- 2022
23. Multidisciplinary Management of Adolescent and Young Adult Patients with Hodgkin Lymphoma
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Emily, Galloway, Melody, Griffith, and Allison, Rosenthal
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Adult ,Patient Care Team ,Integrative Medicine ,Young Adult ,Adolescent ,Recurrence ,Humans ,Standard of Care ,Psychiatric Rehabilitation ,Hodgkin Disease - Abstract
Successful management of adolescent and young adult patients with Hodgkin lymphoma (HL) requires a multidisciplinary approach to care with special attention paid to the unique medical, logistical, and psychosocial challenges faced by this group. The emotional and social changes and big life transitions that occur between the ages of 15 and 39 result in a broad scope of supportive care needs that differ from children or adults in similar circumstances. Currently, care of adolescent and young adult (AYA) patients with HL may be fractured across the pediatric-adult cancer care continuum resulting in this group being less well studied than pediatric or adult patients in general. In order to optimize outcomes, these patients need access to medical oncologists and radiation oncologists, advanced practice providers (APPs), psychologists/social work, financial support services, fertility specialists, survivorship care, and advocates with AYA expertise that can help navigate the healthcare system. A strong AYA support system established early with targeted education and resources may influence treatment compliance and likelihood of long-term follow-up. Surveys of the AYA cancer population have identified areas of opportunity for the healthcare team to collaborate to identify needs, design interventions to meet them, and ultimately develop evidence-based guidelines that will enable us to offer AYAs with HL the quality care they deserve.
- Published
- 2021
24. Abstract 16493: Comparison of Left Ventricular Volumes and Ejection Fraction Measured by Non-contrast 2 Dimensional, Contrast 2 Dimensional and 3 Dimensional Transthoracic Echocardiography in Patients With Heart Failure During One Examination, to Measurements by Cardiovascular Magnetic Resonance Imaging
- Author
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Vibhav Rangarajan, Bliss Uribe, Theresa Green, Mani A. Vannan, Katherine C Lee, Allison Rosenthal, Hassan S. Sayegh, Sara Mobasseri, Peter Flueckiger, J.D. Cochran, Shaefali Padiyar, and Shizhen Liu
- Subjects
medicine.medical_specialty ,Ejection fraction ,Ventricular function ,medicine.diagnostic_test ,business.industry ,media_common.quotation_subject ,Magnetic resonance imaging ,medicine.disease ,Physiology (medical) ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Contrast (vision) ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Ventricular remodeling ,media_common - Abstract
Introduction: Non-contrast 2D TTE (2D NC TTE) is done in patients with HF to assess LV EDV and ESV and EF. 2D contrast and 3D TTE (2D C TTE, 3D TTE) are also done. Hypothesis: There are no distinct cut-offs for LV volumes for 2D C TTE or 3D TTE volumes. And, it is not known which of these measurements should be reported. The relative differences in these measurements, and their relative accuracy, compared to CMR is unknown. Methods: This is an observational, retrospective analysis of 239 HF patients who had 2D NC, 2D C, 3D TTE, and CMR. We measured bi-plane LV EDV and ESV, ml), and EF (%) in the 2D NC and C TTEs, and 3D LV EDV and ESV were measured in one TTE. Results: Data from 35 of the 239 patients are shown. 2D NC LV volumes were significantly smaller than 2D C volumes (EDV: 189±80 Vs. 227±86 and ESV: 133±68 Vs. 158±77, ponly 2D C EDV was significantly smaller than 3D TTE (227±86 Vs. 206±85, p Conclusions: In HF, 2D NC is smaller than 2D C TTE LV volumes, the latter being larger and comparable to CMR. Thus, there is a need to identify specific cut-offs for contrast TTE LV volumes to classify LV size. 3D TTE volumes are comparable to CMR, but smaller than 2D C TTE volumes. Contrast 3D TTE may prove to be most comparable to CMR when this becomes available.
- Published
- 2020
25. Immune Reconstitution Post CAR-T - A Role for the Immunologist in Unlocking the CAR-Key?
- Author
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Catherine Freeman, Matthew Rank, Alyssa Camargo, and Allison Rosenthal
- Subjects
Immunology ,Immunology and Allergy - Published
- 2022
26. Primary cutaneous CD4
- Author
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Jake G, Besch-Stokes, Collin M, Costello, Kevin J, Severson, Puneet, Bhullar, Jordan, Montoya, Richard J, Butterfield, David J, DiCaudo, Nneka, Comfere, Jason, Sluzevich, William, Rule, Fiona E, Craig, Allison, Rosenthal, Mark R, Pittelkow, and Aaron R, Mangold
- Subjects
CD4-Positive T-Lymphocytes ,Skin Neoplasms ,Humans ,Lymphoproliferative Disorders ,Lymphoma, T-Cell, Cutaneous ,Skin - Published
- 2020
27. Primary Effusion Lymphoma: A Clinicopathologic Perspective
- Author
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Diamone Gathers, Emily Galloway, Katalin Kelemen, Allison Rosenthal, Sarah Gibson, and Javier Munoz
- Subjects
HIV positive ,Cancer Research ,Oncology ,hemic and lymphatic diseases ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,virus diseases ,CAR-T therapy ,RC254-282 ,primary effusion lymphoma - Abstract
Primary effusion lymphoma (PEL) is a rare, aggressive B-cell lymphoma that usually localizes to serous body cavities to subsequently form effusions in the absence of a discrete mass. Although some tumors can develop in extracavitary locations, the areas most often affected include the peritoneum, pleural space, and the pericardium. PEL is associated with the presence of human herpesvirus 8 (HHV8), also called the Kaposi sarcoma-associated herpesvirus (KSHV), with some variability in transformation potential suggested by frequent coinfection with the Epstein-Barr virus (EBV) (~80%), although the nature of the oncogenesis is unclear. Most patients suffering with this disease are to some degree immunocompromised (e.g., Human immunodeficiency virus (HIV) infection or post-solid organ transplantation) and, even with aggressive treatment, prognosis remains poor. There is no definitive guideline for the treatment of PEL, although CHOP-like regimens (cyclophosphamide, doxorubicin, vincristine, and prednisone) are frequently prescribed and, given the rarity of this disease, therapeutic focus is being redirected to personalized and targeted approaches in the experimental realm. Current clinical trials include the combination of lenalidomide and rituximab into the EPOCH regimen and the treatment of individuals with relapsed/refractory EBV-associated disease with tabelecleucel.
- Published
- 2022
28. Poster: IBCL-085: Assessment of Fixed-Duration Therapies for Treatment-Naïve Waldenström Macroglobulinemia
- Author
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Jithma Abeykoon, Saurabh Zanwar, Stephen Ansell, Eli Muchtar, Rong He, Patricia Greipp, Rebecca King, Sikander Ailawadhi, Jonas Paludo, Jeremy Larsen, Thomas Habermann, David Inwards, Ronald Go, Gita Thanarajasingam, Francis Buadi, Angela Dispenzieri, Carrie Thompson, Thomas Witzig, Martha Lacy, Wilson Gonsalves, Grzegorz Nowakowski, David Dingli, S. Vincent Rajkumar, Robert Kyle, Taimur Sher, Vivek Roy, Allison Rosenthal, Asher Chanan-Khan, Craig Reeder, Morie Gertz, Shaji Kumar, and Prashant Kapoor
- Subjects
Cancer Research ,Oncology ,Hematology - Published
- 2021
29. CAR-T cell therapy in neuro-oncology: applications and toxicity
- Author
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Marie F. Grill, Akanksha Sharma, Allison Rosenthal, Gustavo De Leon, Kristin R. Swanson, Maciej M. Mrugala, Alyx B. Porter, and Christine E. Brown
- Subjects
0301 basic medicine ,business.industry ,Neuro oncology ,medicine.medical_treatment ,Immunology ,Brain tumor ,Immunotherapy ,medicine.disease ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Neurology ,Toxicity ,Cancer research ,CAR T-cell therapy ,Medicine ,Neurology (clinical) ,Car t cells ,business ,030217 neurology & neurosurgery - Published
- 2018
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