105 results on '"Rybicki, Lisa A."'
Search Results
2. Magnetic resonance imaging as a diagnostic tool for breast cancer in premenopausal women
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Wright, Heather, Listinsky, Jay, Rim, Alice, Chellman-Jeffers, Melanie, Patrick, Rebecca, Rybicki, Lisa, Kim, Julian, and Crowe, Joseph
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Magnetic resonance imaging -- Usage ,Breast cancer -- Diagnosis ,Middle aged women -- Medical examination ,Health - Published
- 2005
3. Impact of induction concurrent chemoradiotherapy on pulmonary function and postoperative acute respiratory complications in esophageal cancer *
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Abou-Jawde, Rony M., Mekhail, Tarek, Adelstein, David J., Rybicki, Lisa A., Mazzone, Peter J., Caroll, Marjorie A., and Rice, Thomas W.
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Chemotherapy -- Patient outcomes ,Respiration disorders -- Diagnosis -- Care and treatment -- Patient outcomes ,Cancer -- Chemotherapy ,Radiotherapy -- Patient outcomes ,Esophageal cancer -- Diagnosis -- Care and treatment -- Patient outcomes ,Health ,Diagnosis ,Care and treatment ,Patient outcomes - Abstract
Study objective: To evaluate the effects of induction concurrent chemoradiotherapy (cCRT) on pulmonary function and postoperative acute respiratory complications (PARCs). Design: A retrospective review of our patients treated with induction [...]
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- 2005
4. Is resection of pulmonary and hepatic metastases warranted in patients with colorectal cancer?
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Robinson, Brigitta J., Rice, Thomas W., Strong, Scott A., Rybicki, Lisa A., and Blackstone, Eugene H.
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Cancer patients -- Care and treatment ,Metastasis -- Care and treatment ,Colorectal cancer -- Care and treatment ,Surgery ,Health - Abstract
Byline: Brigitta J. Robinson, Thomas W. Rice, Scott A. Strong, Lisa A. Rybicki, Eugene H. Blackstone Abstract: Background: Conventional management of stage IV colorectal carcinoma is palliative. The value of resecting both liver and lung colorectal metastases that occur in isolation of other sites of metastasis is undetermined. Objectives: Our objectives were to (1) assess the efficacy of resecting both hepatic and pulmonary metastases, (2) investigate the influence of the sequence and timing of metastases, and (3) identify the profile of patients likely to benefit from both hepatic and pulmonary metastasectomy. Patients and methods: Of 48 patients identified with resection of colorectal cancer and, at some point in time, both liver and lung metastases, 25 patients underwent metastasectomy (resection group). The remaining 23 patients comprised the nonresection group. Risk factors for death were identified by multivariable analyses. Results: Median survival was longer after the last metastatic appearance in the resection group (16 months) than in the nonresection group (6 months; P < .001). The pattern of risk also differed; it peaked at 2 years and then declined in the resection group but was constant in the nonresection group. In the resection group, patients with metachronous resections survived longer after colorectal resection (median, 70 months) than patients with synchronous (median, 22 months) or mixed resections (median, 31 months; P < .001). Risk factors for death included older age, multiple liver metastases, and a short disease-free interval. Conclusions: Younger patients with solitary metachronous metastases to the liver, then the lung, and long disease-free intervals are more likely to benefit from resection of both liver and lung metastases. Patients with risk factors also had better survival with resection than without resection. (J Thorac Cardiovasc Surg 1999;117:66-76) Author Affiliation: From the Departments of Thoracic and Cardiovascular Surgery,.sup.a Colorectal Surgery,.sup.b and Biostatistics and Epidemiology,.sup.c The Cleveland Clinic Foundation, Cleveland, Ohio Article History: Received 8 May 1998; Revised 8 July 1998; Revised 10 September 1998; Accepted 14 September 1998 Article Note: (footnote) [star] Address for reprints: Thomas W. Rice, MD, The Cleveland Clinic Foundation, Desk F25, 9500 Euclid Ave, Cleveland, OH 44195., [star][star] 12/6/94491
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- 1999
5. Therapeutic Dose Monitoring of Busulfan Is Associated with Reduced Risk of Relapse in Non-Hodgkin Lymphoma Patients Undergoing Autologous Stem Cell Transplantation.
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Hill, Brian T., Rybicki, Lisa A., Urban, Theresa A., Lucena, Mariana, Jagadeesh, Deepa, Gerds, Aaron T., Dean, Robert M., Sobecks, Ronald M., Pohlman, Brad, Bolwell, Brian, Kalaycio, Matt E., Hamilton, Betty K., Copelan, Edward A., and Majhail, Navneet S.
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BUSULFAN , *STEM cell transplantation , *MANTLE cell lymphoma , *DRUG monitoring , *DRUG metabolism , *LYMPHOMAS - Abstract
• Previous studies have shown that pharmacokinetic (PK)-directed therapeutic dose monitoring (TDM) of i.v.-administered busulfan results in a larger proportion of patients receiving desired busulfan exposure. • Comparison of PK-directed dosing of busulfan as part of preparative regimen for autologous stem cell transplantation (ASCT) did not appear to improve outcomes of historical controls with non-Hodgkin lymphoma (NHL) treated with standard BEAM chemotherapy, but a prospective trial showed improved relapse and nonrelapse morality in patients with AML/MDS undergoing allogeneic stem cell transplantation with PK-directed versus weight-based dosing of busulfan. • In the present study of sequential cohorts of patients with NHL undergoing ASCT using weight-based dosing or TDM of busulfan, we found improvements in relapse rates and progression-free survival using TDM. Optimal administration of busulfan (Bu) is hampered by variable and unpredictable drug metabolism in individual patients. At our institution, Bu was previously administered with fixed weight-based dosing (WBD) in combination with cyclophosphamide (Cy) and etoposide (E) for patients with non-Hodgkin lymphoma (NHL) undergoing autologous stem cell transplantation (ASCT). In 2014, we adopted real-time pharmacokinetic (PK)-guided therapeutic drug monitoring (TDM) of Bu for all NHL patients undergoing Bu-containing ASCT. Here we compare outcomes of NHL patients who underwent ASCT with Bu/Cy/E using WBD and those who did so using TDM of Bu. We studied 336 consecutive adult NHL patients who underwent ASCT with Bu/Cy/E using WBD from January 2007 to December 2013 (n = 258) or TDM from May 2014 to December 2017 (n = 78), excluding patients with mantle cell lymphoma. Clinical outcomes, including relapse, nonrelapse mortality (NRM), progression-free survival (PFS), and overall survival (OS), hepatotoxicity and pulmonary toxicity were compared in the 2 groups. To adjust for differences in baseline characteristics between the groups, propensity-matched cohorts of WBD and TDM patients were also studied. After the first dose of Bu, the dose was increased in 36% of the patients and decreased in 41%. Changes in pulmonary and liver function from baseline to transplantation were not different between the 2 groups, although these changes showed significantly less variability with TDM than with WBD. Relapse was significantly lower and PFS was improved with TDM; 2-year estimates were 19% for TDM and 38% for WBD for relapse (P =.004) and 69% and 55%, respectively, for PFS (P =.038). No significant between-group differences in NRM or OS were seen. In multivariable analysis, TDM remained prognostic for lower risk of relapse (hazard ratio [HR],.52; 95% confidence interval [CI],.30 to.89; P =.018), but did not remain prognostic for PFS (HR,.74; 95% CI,.48 to 1.16; P =.19). Propensity-matched cohorts displayed similar patterns of outcomes. In subset analysis based on disease status at ASCT, TDM was associated with less relapse and better PFS than WBD for patients who underwent transplantation in less than complete remission (CR) compared with those who underwent transplantation in CR. Compared with WBD, PK-directed TDM of Bu reduces the incidence of relapse when used in combination with Cy and E for patients with NHL undergoing ASCT, particularly for patients in less than CR. These data support the continued use of personalized PK-guided dosing for all NHL patients undergoing ASCT with Bu-containing preparative regimens. [ABSTRACT FROM AUTHOR]
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- 2020
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6. Primary Care Physician Perspectives on Caring for Adult Survivors of Hematologic Malignancies and Hematopoietic Cell Transplantation.
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Mani, Shylaja, Khera, Nandita, Rybicki, Lisa, Marneni, Naimisha, Carraway, Hetty, Moore, Halle, Whited, Helen, and Majhail, Navneet S.
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- 2020
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7. Conditional Long-Term Survival after Autologous Hematopoietic Cell Transplantation for Diffuse Large B Cell Lymphoma.
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El-Asmar, Jessica, Rybicki, Lisa, Bolwell, Brian J., Kharfan-Dabaja, Mohamed A., Dean, Robert, Hamilton, Betty K., Hanna, Rabi, Jagadeesh, Deepa, Kalaycio, Matt, Pohlman, Brad, Sobecks, Ronald, Hill, Brian T., and Majhail, Navneet S.
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CELL transplantation , *B cells , *AUTOGRAFTS , *LYMPHOMAS , *PROGRESSION-free survival - Abstract
• Survival improves with longer time in remission after autologous transplant for DLBCL. • Mortality risk approaches that of the general population with time. • Older age at transplant and relapse are associated with overall mortality risk. Autologous hematopoietic cell transplantation (AHCT) is standard therapy for patients with chemosensitive, relapsed, diffuse large B cell lymphoma (DLBCL). We performed a retrospective cohort study to delineate subsequent (conditional) and relative survival in 371 adult patients with DLBCL who underwent AHCT between 2000 and 2014 and had survived for 1, 2, 3, or 5 years after transplant. The probability of overall survival at 10 years after AHCT was 62%, 71%, 77%, and 86%, respectively, for the 4 cohorts, whereas that of progression-free survival (PFS) was 55%, 65%, 72%, and 81%, respectively. The respective cumulative incidence of nonrelapse mortality (NRM) at 10 years after transplantation was 13%, 12%, 11%, and 8%, respectively. In multivariable analysis, older age was associated with greater mortality risk among all but 5-year survivors; relapse within the landmark time was associated with greater mortality risk in all groups. Older age and relapse within the landmark time were associated with worse PFS in all groups. Standardized mortality ratio (SMR) was significantly higher than an age-, gender-, and race-matched general population, with the magnitude of SMR decreasing as the landmark time increased (4.0 for 1-year, 3.0 for 2-year, 2.4 for 3-year, and 1.8 for 5-year survivors). Our study provides information on long-term survival and prognosis that will assist in counseling patients with DLBCL who have received AHCT. Survival improves with longer time in remission post-transplant, although patients continue to remain at risk for NRM, underscoring the need for continued vigilance and prevention of late complications. [ABSTRACT FROM AUTHOR]
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- 2019
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8. Does ultrasound core breast biopsy predict histologic finding on excisional biopsy?
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Crowe, Joseph P., Patrick, Rebecca J., Rybicki, Lisa A., Grundfest, Sharon F., Kim, Julian A., Lee, Katherine B., and Rim, Alice
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Breast -- Ultrasonic imaging ,Breast -- Research ,Breast -- Biopsy ,Breast -- Patient outcomes ,Breast cancer -- Diagnosis ,Health - Published
- 2003
9. A prospective review of the decline of excisional breast biopsy
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Crowe, Joseph P., Jr., Rim, Alice, Patrick, Rebecca, Rybicki, Lisa, Grundfest, Sharon, Kim, Julian, Lee, Katherine, and Levy, Lawrence
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Breast cancer -- Diagnosis ,Breast -- Biopsy ,Health - Published
- 2002
10. Prognostic Factors for Mortality among Day +100 Survivors after Allogeneic Hematopoietic Cell Transplantation.
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Patel, Sagar S., Rybicki, Lisa A., Corrigan, Donna, Bolwell, Brian, Dean, Robert, Liu, Hien, Gerds, Aaron T., Hanna, Rabi, Hill, Brian, Jagadeesh, Deepa, Kalaycio, Matt, Pohlman, Brad, Sobecks, Ronald, Majhail, Navneet S., and Hamilton, Betty K.
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HEMATOPOIETIC stem cell transplantation , *HOMOGRAFTS , *BONE marrow transplantation , *MULTIVARIABLE testing , *CYTOMEGALOVIRUS diseases - Abstract
Although day +100 survival among allogeneic hematopoietic cell transplantation (HCT) recipients has improved over time, longer-term survival remains a challenge. The aim of this study was to identify prognostic factors for survival among patients surviving longer than 100 days using baseline characteristics and factors identified within the first 100 days after transplantation. Of 413 patients undergoing a first allogeneic HCT between 2006 and 2014, 335 survived >100 days post-transplantation. The majority underwent a myeloablative transplantation (75%) with a bone marrow (BM) (52%) graft source. One-year all-cause mortality (ACM) was 29%, with 16% relapse mortality (RM) and 12% nonrelapse mortality. In multivariable analysis, high-risk disease (hazard ratio [HR], 1.55; P = .003), non-cytomegalovirus infection (HR, 1.79; P = .003), more days hospitalized (HR, 1.16; P < .001), and relapse (HR, 4.38; P < .001) within the first 100 days were associated with increased risk of ACM. Patients with higher income (HR, .89; P = .024) and those who received BM (HR, .52; P < .001) or umbilical cord blood (HR, .40; P = .002) relative to peripheral blood stem cells had lower risk of ACM. Our study identifies risk factors for adverse long-term survival in 100-day survivors, a time point when patients frequently are discharged from transplantation centers. In addition to disease- and transplantation-related factors, low socioeconomic status was associated with worse long-term survival, highlighting the need for focused efforts to improve outcomes in vulnerable patient populations. [ABSTRACT FROM AUTHOR]
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- 2018
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11. Association of Socioeconomic Status with Chronic Graft-versus-Host Disease Outcomes.
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Hamilton, Betty K., Rybicki, Lisa, Arai, Sally, Arora, Mukta, Cutler, Corey S., Flowers, Mary E.D., Jagasia, Madan, Martin, Paul J., Palmer, Jeanne, Pidala, Joseph, Majhail, Navneet S., Lee, Stephanie J., and Khera, Nandita
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GRAFT versus host disease , *GRAFT versus host disease prevention , *HEMATOPOIETIC stem cell transplantation , *BONE marrow transplant complications , *RETURN to work programs , *QUALITY of life , *SOCIAL status , *THERAPEUTICS - Abstract
Chronic graft-versus host disease (GVHD) is a chronic and disabling complication after hematopoietic cell transplantation (HCT). It is important to understand the association of socioeconomic status (SES) with health outcomes in patients with chronic GVHD because of the impaired physical health and dependence on intensive and prolonged health care utilization needs in these patients. We evaluated the association of SES with survival and quality of life (QOL) in a cohort of 421 patients with chronic GVHD enrolled on the Chronic GVHD Consortium Improving Outcomes Assessment study. Income, education, marital status, and work status were analyzed to determine the associations with patient-reported outcomes at the time of enrollment, nonrelapse mortality (NRM), and overall mortality. Higher income ( P = .004), ability to work ( P < .001), and having a partner ( P = .021) were associated with better mean Lee chronic GVHD symptom scores. Higher income ( P = .048), educational level ( P = .044), and ability to work ( P < .001) also were significantly associated with better QOL and improved activity. In multivariable models, higher income and ability to return to work were both significantly associated with better chronic GVHD Lee symptom scores, but income was not associated with activity level, QOL, or physical/mental functioning. The inability to return to work (hazard ratio, 1.82; P = .019) was associated with worse overall mortality, whereas none of the SES indicators were associated with NRM. Income, race, and education did not have statistically significant associations with survival. In summary, we did not observe an association between SES variables and survival or NRM in patients with chronic GVHD, although we found some association with patient-reported outcomes, such as symptom burden. Higher income status was associated with less severe chronic GVHD symptoms. More research is needed to understand the psychosocial, biological, and environmental factors that mediate this association of SES with major HCT outcomes. [ABSTRACT FROM AUTHOR]
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- 2018
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12. Long-Term Outcomes of Hairy Cell Leukemia Treated With Purine Analogs: A Comparison With the General Population.
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Madanat, Yazan F., Rybicki, Lisa, Radivoyevitch, Tomas, Jagadeesh, Deepa, Dean, Robert, Pohlman, Brad, Kalaycio, Matt, Sekeres, Mikkael A., Smith, Mitchell R., and Hill, Brian T.
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- 2017
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13. Grade 3 Follicular Lymphoma: Outcomes in the Rituximab Era.
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Mustafa Ali, Moaath, Rybicki, Lisa, Nomani, Laila, Rouphail, Basel, Dean, Robert M., Hill, Brian T., Jagadeesh, Deepa, Pohlman, Brad, Hsi, Eric D., and Smith, Mitchell R.
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- 2017
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14. Allogeneic Hematopoietic Cell Transplantation for Adult T Cell Acute Lymphoblastic Leukemia.
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Hamilton, Betty Ky, Rybicki, Lisa, Abounader, Donna, Adekola, Kehinde, Advani, Anjali, Aldoss, Ibrahim, Bachanova, Veronika, Bashey, Asad, Brown, Stacey, DeLima, Marcos, Devine, Steven, Flowers, Christopher R., Ganguly, Siddharth, Jagasia, Madan, Kennedy, Vanessa E., Kim, Dennis Dong Hwan, McGuirk, Joseph, Pullarkat, Vinod, Romee, Rizwan, and Sandhu, Karamjeet
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HEMATOPOIETIC stem cell transplantation , *LYMPHOBLASTIC leukemia , *T cells , *TOTAL body irradiation , *CORD blood , *PHYSIOLOGY - Abstract
Allogeneic hematopoietic cell transplantation (HCT) is recommended for patients with T cell acute lymphoblastic leukemia (T-ALL) in second or later complete remission (CR) and high-risk patients in first CR. Given its relative rarity, data on outcomes of HCT for T-ALL are limited. We conducted a multicenter retrospective cohort study using data from 208 adult patients who underwent HCT between 2000 and 2014 to describe outcomes of allogeneic HCT for T-ALL in the contemporary era. The median age at HCT was 37 years, and the majority of patients underwent HCT in CR, using total body irradiation (TBI)-based myeloablative conditioning regimens. One-quarter of the patients underwent alternative donor HCT using a mismatched, umbilical cord blood, or haploidentical donor. With a median follow up of 38 months, overall survival at 5 years was 34%. The corresponding cumulative incidence of non-relapse mortality and relapse was 26% and 41%, respectively. In multivariable analysis, factors significantly associated with overall survival were the use of TBI (HR, 0.57; P = .021), age >35 years (HR, 1.55; P = .025), and disease status at HCT (HR, 1.98; P = .005 for relapsed/refractory disease compared with CR). Relapse was the most common cause of death (58% of patients). Allogeneic HCT remains a potentially curative option in selected patients with adult T-ALL, although relapse is a major cause of treatment failure. [ABSTRACT FROM AUTHOR]
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- 2017
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15. Daily Weight-Based Busulfan with Cyclophosphamide and Etoposide Produces Comparable Outcomes to Four-Times–Daily Busulfan Dosing for Lymphoma Patients Undergoing Autologous Stem Cell Transplantation.
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Hill, Brian T., Rybicki, Lisa, Carlstrom, Kelley D., Jagadeesh, Deepa, Gerds, Aaron, Hamilton, Betty, Liu, Hien, Dean, Robert, Sobecks, Ronald, Pohlman, Brad, Andresen, Steven, Kalaycio, Matt, Bolwell, Brian J., and Majhail, Navneet S.
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CYCLOPHOSPHAMIDE , *BUSULFAN , *ETOPOSIDE , *LYMPHOMA treatment , *STEM cell transplantation , *DRUG efficacy , *DRUG side effects , *THERAPEUTICS - Abstract
High-dose busulfan (Bu) is an integral component of commonly used preparative regimens for both allogeneic and autologous transplantation. There is significant interest in comparing the efficacy and toxicity of administering Bu every 6 (Bu6) or every 24 hours (daily Bu). To facilitate a therapeutic dose-monitoring protocol, we transitioned from Bu6 to daily Bu dosing for patients with Hodgkin and non-Hodgkin lymphoma undergoing autologous stem cell transplantation (ASCT). Here, we retrospectively review outcomes of 400 consecutive eligible lymphoma patients who underwent ASCT from 2007 to 2013 with high-dose busulfan (Bu), cyclophosphamide (Cy), and etoposide (E). Bu was given at a fixed dose of either .8 mg/kg every 6 hours for 14 doses for 307 patients or a fixed dose of 2.8 mg/kg every 24 hours for 4 doses (days −9 through −6) for 93 patients who underwent transplantation after the transition from Bu6 to daily Bu was made. Toxicity was assessed using pulmonary and liver function tests (LFT) at specified time points before and after ASCT. Baseline patient and disease characteristics of patients dosed with Bu6 and daily Bu were similar. There was no significant difference in forced expiratory volume in 1 second or diffusing capacity of the lungs for carbon monoxide before and after transplantation in the Bu6 versus daily Bu cohorts. Changes in LFTs with daily Bu were not significantly different than those with Bu6. There were no differences in relapse, nonrelapse mortality, progression-free survival, or overall survival between Bu6 and Bu 24 administration schedules in univariable or multivariable analysis ( P ≥ .34). For a subset of 23 patients who had first-dose Bu levels measured, we observed significant variation in an median estimated cumulative area under the curve (AUC) of 17,568 µM-minute (range, 12,104 µM-23,084 µM-minute). In conclusion, daily Bu with Cy/E is more convenient than Bu6, has equivalent outcomes, and results in no increase in either hepatic or pulmonary toxicity. Consistent with previous reports, there is a significant range of Bu AUC levels, with a standard deviation of 13%. These data provide rationale for our prospective clinical trial of real-time therapeutic dose monitoring of Bu. [ABSTRACT FROM AUTHOR]
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- 2016
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16. Association of Socioeconomic Status with Outcomes of Autologous Hematopoietic Cell Transplantation for Multiple Myeloma.
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Hong, Sanghee, Rybicki, Lisa, Abounader, Donna, Bolwell, Brian J., Dean, Robert, Gerds, Aaron T., Hamilton, Betty K., Hill, Brian T., Jagadeesh, Deepa, Kalaycio, Matt, Liu, Hien D., Pohlman, Brad, Sobecks, Ronald, and Majhail, Navneet S.
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HEMATOPOIETIC stem cell transplantation , *MULTIPLE myeloma treatment , *RETROSPECTIVE studies , *SOCIOECONOMICS , *CAUCASIAN race , *PROGRESSION-free survival - Abstract
Autologous hematopoietic cell transplantation (AHCT) is standard therapy for eligible patients with multiple myeloma. Health care disparities can influence transplantation outcomes. However, the association of socioeconomic status (SES), a major indicator of health care disparities, with outcomes in patients with myeloma after AHCT has not been previously described. We analyzed 346 consecutive AHCT recipients with myeloma who underwent transplantation between 2003 and 2013 in this retrospective cohort study. Zip code of residence at the time of AHCT was obtained to assess annual household income based on 2010 US census data (median, $49,054; range, $16,546 to $127,313). SES groups were divided into < $45,000 (low; n = 120), $45,000 to $60,000 (middle; n = 116), and > $60,000 (high; n = 110). The low-income cohort had smallest portion of Caucasians (69% versus 89% versus 91%); otherwise, patient, disease, and transplantation characteristics were comparable among cohorts or different without significant patterns found. Median follow-up was 49 months. There was no difference among SES groups in overall survival, progression-free survival, nonrelapse mortality, or relapse in univariate and multivariable analysis. Similarly, SES was not associated with survival in a subset analysis of 303 patients who had survived for 1 year after transplantation. [ABSTRACT FROM AUTHOR]
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- 2016
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17. The impact of induction chemoradiotherapy (CRT) for esophageal cancer on pulmonary function tests (PFTS): correlation with postoperative acute respiratory complications (PARC). (Application of respiratory function in health and disease: 12:00pm-1:45pm)
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Jawde, Rony M Abou, Mekhail, Tarek, Adelstein, David, Rybicki, Lisa, Mazzone, Peter, Chidel, Mark, Caroll, Marjorie, and Rice, Thomas
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Health - Abstract
PURPOSE: To determine the effect of induction CRT on PFTs and identify predictors of PARC in patients (pts) with esophageal cancer. METHODS: Pts treated on clinical trials of induction CRT [...]
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- 2002
18. Community Risk Score for Evaluating Health Care Disparities in Hematopoietic Cell Transplantation.
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Hong, Sanghee, Rybicki, Lisa A., Corrigan, Donna, Schold, Jesse D., and Majhail, Navneet S.
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HEALTH equity , *CELL transplantation , *HEMATOPOIETIC stem cell transplantation , *GRAFT versus host disease , *PUBLIC health - Abstract
There is a critical need for tools to comprehensively describe disparities in hematopoietic cell transplant (HCT) recipients. We conducted a retrospective cohort study to evaluate a Community Risk Score (CRS) tool for this purpose. CRS included 10 community health indicators based on county or state of residence obtained from several secondary data sources and a composite score was assigned to each county (range 0 to 40), that was further categorized into six tiers (I to VI) with higher tiers indicating poor community health. CRS was assessed for 509 allogeneic and 1033 autologous HCT recipients from 2003 to 2013. Our cohort represented allogeneic and autologous HCT recipients from 300 and 431 unique ZIP codes from 99 and 125 counties in 15 and 16 states, although 86% and 90% patients were from Ohio, respectively. A greater proportion of patients had adverse individual community risk indicators in higher-risk tiers ( P < .001 for trend for all). In multivariable analysis, clear trends toward association of CRS with outcomes were not observed. For autologous HCTs, Tier III has higher risks of relapse mortality (hazard ratio [HR] 2.2, P = .02) and all-cause mortality (HR 1.8, P = 0.03). In conclusion, CRS was able to categorize patients into groups representing greater levels of health care disparities. We did not see a clear association between CRS and transplant outcomes, although our cohort was limited to a relatively small group of counties. Community-based risk score model may serve as a tool for evaluating disparities in HCT recipients, but its validation in a nationally representative cohort of patients is needed. [ABSTRACT FROM AUTHOR]
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- 2018
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19. A Phase II Trial of Induction Epirubicin, Oxaliplatin, and Fluorouracil, Followed by Surgery and Postoperative Concurrent Cisplatin and Fluorouracil Chemoradiotherapy in Patients with Locoregionally Advanced Adenocarcinoma of the Esophagus and Gastroesophageal Junction.
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McNamara, Michael J, Adelstein, David J, Bodmann, Joanna W, Greskovich Jr, John F, Ives, Denise I, Mason, David P, Murthy, Sudish C, Rice, Thomas W, Saxton, Jerrold P, Sohal, Davendra, Stephans, Kevin, Rodriguez, Cristina P, Videtic, Gregory M M, and Rybicki, Lisa A
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- 2014
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20. Clinical characteristics of 95 patients with ocular adnexal and uveal lymphoma: treatment outcomes in extranodal marginal zone subtype.
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Portell, Craig A, Aronow, Mary E, Rybicki, Lisa A, Macklis, Roger, Singh, Arun D, and Sweetenham, John W
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- 2014
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21. Prevalence of Germline PTEN, BMPR1A, SMAD4, STK11, and ENG Mutations in Patients With Moderate-Load Colorectal Polyps.
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NGEOW, JOANNE, HEALD, BRANDIE, RYBICKI, LISA A., ORLOFF, MOHAMMED S., JIN LIAN CHEN, XIULI LIU, YERIAN, LISA, WILLIS, JOSEPH, LEHTONEN, HELI J., LEHTONEN, RAINER, MESTER, JESSICA L., MOLINE, JESSICA, BURKE, CAROL A., CHURCH, JAMES, AALTONEN, LAURI A., and ENG, CHARIS
- Abstract
BACKGROUND & AIMS: Gastrointestinal polyposis is a common clinical problem, yet there is no consensus on how to best manage patients with moderate-load polyposis. Identifying genetic features of this disorder could improve management and especially surveillance of these patients. We sought to determine the prevalence of hamartomatous polyposis-associated mutations in the susceptibility genes PTEN, BMPRIA, SMAD4, ENG, and STKII in individuals with ≥ 5 gastrointestinal polyps, including at least 1 hamartomatous or hyperplastic/serrated polyp. METHODS: We performed a prospective, referral-based study of 603 patients (median age: 51 years; range, 2-89 years) enrolled from June 2006 through January 2012. Genomic DNA was extracted from peripheral lymphocytes and analyzed for specific mutations and large rearrangements in PTEN, BMPR1A, SMAD4, and STKI1, as well as mutations in ENG. Recursive partitioning analysis was used to determine cutoffs for continuous variables. The prevalence of mutations was compared using Fisher's exact test. Logistic regression analyses were used to determine univariate and multivariate risk factors. RESULTS: Of 603 patients, 119 (20%) had a personal history of colorectal cancer and most (n = 461 [76%]) had <30 polyps. Seventy-seven patients (13%) were found to have polyposis-associated mutations, including 11 in ENG (1.8%), 13 in PTEN (2.2%), 13 in STKI1 (2.2%), 20 in BMPRIA (3.3%), and 21 in SMAD4 (3.5%). Univariate clinical predictors for risk of having these mutations included age at presentation younger than 40 years (19% vs 10%; P = .008), a polyp burden of ≥ 30 (19% vs 11%; P = .014), and male sex (16% vs 10%; P = .03). Patients who had ≥ 1 ganglioneuroma (29% vs 2%; P < .001) or presented with polyps of ≥ 3 histologic types (20% vs 2%; P = .003) were more likely to have germline mutations in PTEN. CONCLUSIONS: Age younger than 40 years, male sex, and specific polyp histologies are significantly associated with risk of germline mutations in hamartomatous-polyposis associated genes. These associations could guide clinical decision making and further investigations. [ABSTRACT FROM AUTHOR]
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- 2013
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22. Defining Incidence, Risk Factors, and Impact on Survival of Central Line-Associated Blood Stream Infections Following Hematopoietic Cell Transplantation in Acute Myeloid Leukemia and Myelodysplastic Syndrome
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Lukenbill, Joshua, Rybicki, Lisa, Sekeres, Mikkael A., Zaman, Muhammad Omer, Copelan, Alexander, Haddad, Housam, Fraser, Thomas, DiGiorgio, Megan J., Hanna, Rabi, Duong, Hien, Hill, Brian, Kalaycio, Matt, Sobecks, Ronald, Bolwell, Brian, and Copelan, Edward
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CENTRAL venous catheters , *DISEASE risk factors , *HEMATOPOIETIC stem cell transplantation , *ACUTE myeloid leukemia , *MYELODYSPLASTIC syndromes , *DISEASE incidence , *RETROSPECTIVE studies - Abstract
Abstract: Central line-associated blood stream infections (CLABSI) commonly complicate the care of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) after allogeneic stem cell transplantation (HCT). We developed a modified CLABSI (MCLABSI) definition that attempts to exclude pathogens usually acquired because of disruption of mucosal barriers during the vulnerable neutropenic period following HCT that are generally included under the original definition (OCLABSI). We conducted a retrospective study of all AML and MDS patients undergoing HCT between August 2009 and December 2011 at the Cleveland Clinic (N = 73), identifying both OCLABSI and MCLABSI incidence. The median age at transplantation was 52 years (range, 16 to 70); 34 had a high (≥3) HCT comorbidity index (HCT-CI); 34 received bone marrow (BM), 24 received peripheral stem cells (PSC), and 15 received umbilical cord blood cells (UCB). Among these 73 patients, 23 (31.5%) developed OCLABSI, of whom 16 (69.6%) died, and 8 (11%) developed MCLABSI, of whom 7 (87.5%) died. OCLABSI was diagnosed a median of 9 days from HCT: 5 days (range, 2 to 12) for UCB and 78 days (range, 7 to 211) for BM/PSC (P < .001). MCLABSI occurred a median of 12 days from HCT, with similar earlier UCB and later BM/PSC diagnosis (P = .030). Risk factors for OCLABSI in univariate analysis included CBC (P < .001), human leukocyte antigen (HLA)-mismatch (P = .005), low CD34+ count (P = .007), low total nucleated cell dose (P = .016), and non-Caucasian race (P = .017). Risk factors for OCLABSI in multivariable analysis were UCB (P < .001) and high HCT-CI (P = .002). There was a significant increase in mortality for both OCLABSI (hazard ratio, 7.14; CI, 3.31 to 15.37; P < .001) and MCLABSI (hazard ratio, 6.44; CI, 2.28 to 18.18; P < .001). CLABSI is common and associated with high mortality in AML and MDS patients undergoing HCT, especially in UCB recipients and those with high HCT-CI. We propose the MCLABSI definition to replace the OCLABSI definition, given its greater precision for identifying preventable infection in HCT patients. [Copyright &y& Elsevier]
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- 2013
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23. Proximal colon cancers and the serrated pathway: a systematic analysis of precursor histology and BRAF mutation status.
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Patil, Deepa T, Shadrach, Bonnie L, Rybicki, Lisa A, Leach, Brandie H, and Pai, Rish K
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- 2012
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24. Clinicopathologic and molecular features of sporadic early-onset colorectal adenocarcinoma: an adenocarcinoma with frequent signet ring cell differentiation, rectal and sigmoid involvement, and adverse morphologic features.
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Chang, Daniel T, Pai, Rish K, Rybicki, Lisa A, Dimaio, Michael A, Limaye, Maneesha, Jayachandran, Priya, Koong, Albert C, Kunz, Pamela A, Fisher, George A, Ford, James M, Welton, Mark, Shelton, Andrew, Ma, Lisa, Arber, Daniel A, and Pai, Reetesh K
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- 2012
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25. Frequent Gastrointestinal Polyps and Colorectal Adenocarcinomas in a Prospective Series of PTEN Mutation Carriers.
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Heald, Brandie, Mester, Jessica, Rybicki, Lisa, Orloff, Mohammed S., Burke, Carol A., and Eng, Charis
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ADENOCARCINOMA ,COLON cancer ,LONGITUDINAL method ,GENETIC mutation ,PHOSPHATASES ,COWDEN syndrome ,THYROID cancer ,HAMARTOMA ,PHENOTYPES - Abstract
Background & Aims: Germline phosphatase and tensin homolog (PTEN) mutations cause Cowden syndrome (CS), associated with breast and thyroid cancers. Case reports found 35%–85% of CS patients had gastrointestinal (GI) hamartomas. The association of benign and malignant GI neoplasias with CS remains debatable. Our goal is to describe the GI phenotype in a prospective series of PTEN mutation carriers. Methods: Patients who met relaxed International Cowden Consortium criteria (N = 2548) or with 5 or more GI polyps, 1 or more of which was hyperplastic or hamartomatous (N = 397), were prospectively recruited. Germline PTEN mutation/deletion analysis was performed. Of the 2945 patients, 127 (123 of 2548 and 4 of 397, respectively) patients having clear pathogenic PTEN mutations were eligible for this study. Esophagogastroduodenoscopy, colonoscopy, and pathology reports were reviewed. The Fisher 2-tailed exact test, unpaired t tests, and age- and sex-adjusted standardized incidence ratio were calculated. Results: Of 127 PTEN mutation carriers, 69 underwent 1 or more endoscopies with 64 (93%) having polyps. Of the 64, half had hyperplastic polyps. There were one to innumerable polyps in the colorectum, ileum, duodenum, stomach, and/or esophagus, with 24 subjects having both upper and lower GI polyps. Nine (13%) subjects had colorectal cancer, all younger than the age of 50. The adjusted standardized incidence ratio was 224.1 (95% confidence interval, 109.3–411.3; P < .0001). Conclusions: PTEN-associated CS should be considered a mixed polyp syndrome, with hyperplastic polyps most prevalent, with a risk of early onset colorectal cancer. Routine colonoscopy should be considered in PTEN-associated CS, especially in the context of hyperplastic and/or adenomatous polyps. [ABSTRACT FROM AUTHOR]
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- 2010
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26. A Phase II Trial of Gemcitabine and Mitoxantrone for Patients With Acute Myeloid Leukemia in First Relapse.
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Advani, Anjali S., Shadman, Mazyar, Ali-Osman, Francis, Barker, Andrew, Rybicki, Lisa, Kalaycio, Matt, Sekeres, Mikkael A., de Castro, Carlos M., Diehl, Louis F., Moore, Joseph O., Beaven, Anne, Copelan, Ed, Sobecks, Ronald, Talea, Parisa, and Rizzieri, David A.
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- 2010
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27. A Phase II Study of Perioperative Concurrent Chemotherapy, Gefitinib, and Hyperfractionated Radiation Followed by Maintenance Gefitinib in Locoregionally Advanced Esophagus and Gastroesophageal Junction Cancer.
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Rodriguez, Cristina P., Adelstein, David J., Rice, Thomas W., Rybicki, Lisa A., Videtic, Gregory M. M., Saxton, Jerrold P., Murthy, Sudish C., Mason, David P., and Ives, Denise I.
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- 2010
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28. Mature Results from a Phase II Trial of Postoperative Concurrent Chemoradiotherapy for Poor Prognosis Cancer of the Esophagus and Gastroesophageal Junction.
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Adelstein, David J., Rice, Thomas W., Rybicki, Lisa A., Saxton, Jerrold P., Videtic, Gregory M. M., Murthy, Sudish C., Mason, David P., Rodriguez, Cristina P., and Ives, Denise I.
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- 2009
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29. Induction Chemoradiotherapy Increases Pleural and Pericardial Complications after Esophagectomy for Cancer.
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Murthy, Sudish C., Rozas, Maria Solovera, Adelstein, David J., Mason, David P., Calhoun, Royce, Rybicki, Lisa A., Feng, Jingyuan, Blackstone, Eugene H., and Rice, Thomas W.
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- 2009
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30. T2N0M0 esophageal cancer.
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Rice, Thomas W., Mason, David P., Murthy, Sudish C., Zuccaro, Gregory, Adelstein, David J., Rybicki, Lisa A., and Blackstone, Eugene H.
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ESOPHAGEAL cancer ,CANCER treatment ,CANCER patients ,THERAPEUTICS - Abstract
Objective: The study objective was to develop a treatment algorithm for cT2N0M0 esophageal cancer by determining (1) errors in clinical staging and (2) consequences of overtreatment and undertreatment of incorrectly clinically staged patients. Methods: Of 742 clinically staged patients, 61 (8.2%) had cT2N0M0 cancer; 45 underwent surgery alone; 8 underwent surgery and postoperative adjuvant therapy; and 8 underwent induction therapy, then surgery. As reference, 31 of 666 patients (4.7%) who underwent surgery first had pT2N0M0 cancer and a 5-year survival of 61% ± 9.3%. Referent values were calculated from 445 clinically staged patients who underwent surgery first. Unmatched and matched survival comparisons were made using the log-rank test. Results: Only 7 of 53 cT2N0M0 cancers treated with surgery first were pT2N0M0 (13% positive predictive value). Of incorrectly staged cT2N0M0 cancers (46/53), 29 (63%) were overstaged and 17 (37%) were understaged. Most overstaged cancers were pT1 (11 [38%] T1a and 15 [52%] T1b), and most understaged cancers were pN1 (13 [76%]). Matched overstaged patients treated by surgery alone (25/28) had a 5-year survival similar to that of patients with pTNM (69% ± 9.8% vs 63% ± 13%, P =.8). Understaged patients did better at 5 years than patients with pTNM if they had postoperative adjuvant therapy, not surgery alone (43% ± 22% vs 10% ± 9.5%, P = .17). Induction therapy decreased 5-year survival compared with all other treatment strategies (13% ± 12% vs 52% ± 7.4%, P =.05). Conclusions: Patients with cT2N0M0 cancers should undergo surgery first with lymphadenectomy. Clinically understaged patients should receive postoperative adjuvant therapy. In the unlikely event that patients with cT2N0M0 cancers are found to have an uncommon pT2N0M0 cancer, they will have acceptable survival with surgery alone. [Copyright &y& Elsevier]
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- 2007
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31. Targeted Treatment and Survival Following Relapse after Allogeneic Hematopoietic Cell Transplantation for Acute Leukemia and Myelodysplastic Syndrome in the Contemporary Era.
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Hong, Sanghee, Rybicki, Lisa, Corrigan, Donna, Hamilton, Betty K., Sobecks, Ronald M., Kalaycio, Matt E., Dean, Robert M., Hill, Brian T., Pohlman, Brad, Jagadeesh, Deepa, Anwer, Faiz, and Majhail, Navneet S.
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CELL transplantation , *MYELODYSPLASTIC syndromes , *ACUTE leukemia , *NATALIZUMAB , *ALEMTUZUMAB , *GRAFT versus host disease , *BONE marrow - Abstract
Relapse is the most frequent cause of treatment failure after allogeneic hematopoietic cell transplantation (alloHCT). While transplant-related mortality has decreased substantially over the last few decades, little progress has been made in outcomes and no standard of care exists for patients (pts) with post-alloHCT relapse. In the recent era, several new therapies, including targeted agents, have been approved for ALL, AML, and MDS. We conducted a study to evaluate outcomes of pts with these diseases who relapse after alloHCT in the contemporary period with routine availability of these newer therapeutic agents. We performed a single-institution retrospective cohort study to review treatment strategies and outcomes of relapse post-alloHCT. We identified 420 adults who received their first alloHCT in 2010-2018 using any conditioning regimen or donor source. Overall, 115 (27%) pts experienced relapse (ALL=17/64 [27%], AML=67/242 [28%], MDS=31/114 [27%]) and were included in the analysis. Myeloablative (54%) matched-unrelated donor grafts (50%) were the most common types of HCTs. Peripheral blood stem cell graft (49%) and bone marrow graft (48%) were used the most. Median time from alloHCT to relapse was 5 (range 1-65) months, and 83% of relapses occurred within the first year. Only 24% and 11% of pts experienced grade II-IV acute and any chronic graft-versus-host disease (GVHD) prior to relapse, respectively. Seven of 17 pts had Ph+ ALL. Mutation panel was tested in 56% of AML and MDS. Median follow-up period after relapse was 19 (range 6-80) months. The estimated survival after relapse is shown in figure 1. Table 1 summarizes the treatments used for relapse after alloHCT. Targeted therapy was associated with a trend towards better survival compared to other therapies (Fig 2, HR 0.65, 95% CI 0.41-1.03, p=0.06). Matched unrelated (vs. matched sibling, HR 1.70, p=0.027) or haploidentical donor grafts (HR 2.69, p=0.003), presence of grade II-IV acute GVHD before relapse (HR 2.46, p<0.001), and <12 months from HCT to relapse (<6 vs. >12 months, HR 6.34, p<0.001; 6-12 vs. >12 months, HR 3.16, p=0.005) were adverse prognostic features with survival after relapse post-alloHCT (Table 2). Outcomes of pts with ALL, AML, and MDS who relapse following alloHCT remain poor in the contemporary era when several newer therapies, including targeted agents, are available for their treatment. Targeted agents were used only in a minority of post-alloHCT relapses likely due to the combination of pt status, absence of the target mutation, the agents' availability, and other factors. Pts who developed grade II-IV acute GVHD and had shorter "disease-free" duration from unrelated or haploidentical donor grafts had the significantly shorter survival following relapse. More innovative treatment strategies to prevent and treat relapse post-alloHCT are needed. [ABSTRACT FROM AUTHOR]
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- 2020
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32. Measuring Patient-Reported Outcomes (PROs) in Allogeneic Hematopoietic Cell Transplant (HCT) Recipients.
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Hamilton, Betty K., Rybicki, Lisa, Strzalka, Colleen, Dabney, Jane, Colver, Amy, Lawrence, Christine, Anwer, Faiz, Dean, Robert M., Gerds, Aaron T., Hill, Brian T., Jagadeesh, Deepa, Kalaycio, Matt E., Pohlman, Brad, Sobecks, Ronald M., and Majhail, Navneet S.
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TELEPHONE calls , *GRAFT versus host disease , *TRANSPLANTATION of organs, tissues, etc. , *INFORMATION measurement , *ACUTE diseases , *INFORMATION storage & retrieval systems - Abstract
PROs are increasingly used in HCT to capture symptoms, quality of life, and functional status. At the Cleveland Clinic, PROs are systematically collected prior to ambulatory visits and used in routine clinical care to identify patients (pts) with distress in real-time through a data capture initiative called the "Knowledge Program." Instruments include the Patient Health Questionnaire (PHQ-9), National Comprehensive Cancer Network Distress Thermometer (DT), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Health (PH) and Mental Health (MH) assessments. There are limited data on the use of these instruments in the HCT population. We evaluated these PRO measures in HCT recipients and their association with post-HCT outcomes. We identified 292 adult pts undergoing first allogeneic HCT from 2015-2018. Of those, 257 had at least one PRO assessment and were included in this analysis. Time intervals evaluated were: pre-HCT (within 3 months [mos]), 0-6 mos, 6-12 mos, 1-2 years (yrs), and 2-5 yrs post HCT. PHQ-9 assesses depression and categorized as minimal (score 0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27). Higher DT scores indicate more distress and categorized as mild (0-3), moderate (4-7), severe (8-10). Lower scores on PROMIS indicate poorer PH or MH respectively. We evaluated PRO data descriptively for each time interval. Pre-HCT scores were analyzed for association with grade 2-4 acute graft-versus-host disease (GVHD), relapse, non-relapse mortality (NRM), and survival. Figure 1 shows boxplots for mean PHQ-9 and DT scores pre- and post-HCT. Mean scores for the PHQ-9 ranged from 1.1 ± 2.4 (SD) occurring >2 yrs post-HCT to 2.4 ± 3.0 pre-HCT. Mean DT scores were overall low, with highest distress (2.0 ± 2.2) seen pre-HCT. Mean scores for PH and MH were similar at each time intervals, with means ranging 47-48 for PH and 49-51 for MH. Higher PHQ-9 pre-HCT was associated with higher NRM (HR 1.21, 95% CI 1.09-1.34, P<0.001) and worse overall mortality (HR 1.12, 95% CI 1.02-1.23, P=0.016). Higher PROMIS PH and MH scores were associated with lower NRM (HR 0.49, 95% CI 0.26-0.94, P=0.031 and HR 0.28, 95% CI 0.14-0.56, P<0.001), respectively. DT scores had no associations with any outcome. Pts who developed acute GVHD had significantly higher PHQ-9 scores (mean 2.8 vs 1.9, P=0.014), PROMIS-PH (mean 45 vs 49, P=0.029) and MH scores (mean 47 vs 52, P=0.011) relative to those who did not have acute GVHD. PROs such as the PHQ-9, DT, and PROMIS have important clinical utility in allogeneic HCT recipients. Routine clinical use of these assessments not only help identify pts with high levels of distress or depression in real-time, they also demonstrate prognostic value for post-HCT survival outcomes. [ABSTRACT FROM AUTHOR]
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- 2020
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33. A data model to predict HER2 status in breast cancer based on the clinical and pathologic profiles of a large patient population at a single institution.
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Crowe, Joseph P., Patrick, Rebecca J., Rybicki, Lisa A., Escobar, Pedro F., Weng, David, Thomas Budd, G., Tubbs, Raymond R., Procop, Gary W., and Hicks, David G.
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CLINICAL medicine ,CANCER patients ,TUMORS ,PATIENTS ,BREAST cancer - Abstract
Summary: Recently published clinical trial data have produced compelling evidence for increased survival when Herceptin is administered to patients whose tumors are HER2 amplified. Therefore, the accuracy of HER2 status is essential to determine which patients should or should not receive Herceptin. Although HER2 results obtained by FISH and IHC are often in agreement, there is a persistent group of cases in which results are discordant, particularly among tumors with intermediate results. A multivariable analysis was undertaken to determine relative significance of various clinical and pathologic findings for patients diagnosed with infiltrating ductal carcinoma, and a data model was produced that predicts which patients are most likely to have HER2 amplified tumors. Correlates of HER2 amplification were higher Scarff–Bloom–Richardson grade, younger age at diagnosis, and a comedo ductal carcinoma in situ component. [Copyright &y& Elsevier]
- Published
- 2006
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34. Brain Metastases From Esophageal Cancer: A Phenomenon of Adjuvant Therapy?
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Rice, Thomas W., Khuntia, Deepak, Rybicki, Lisa A., Adelstein, David J., Vogelbaum, Michael A., Mason, David P., Murthy, Sudish C., and Blackstone, Eugene H.
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METASTASIS ,CANCER risk factors ,ESOPHAGEAL surgery ,ESOPHAGEAL cancer - Abstract
Background: Brain metastases from esophageal cancers are uncommon, yet our impression was that they occurred more frequently than expected after esophagectomy plus adjuvant therapy. Therefore, we determined (1) incidence and prevalence of, risk factors for, and survival after development of brain metastases following esophagectomy for esophageal cancer, and (2) their association with adjuvant therapy. Methods: From 1985 to 2002, 403 patients (52%) underwent esophagectomy alone and 369 esophagectomy plus adjuvant therapy (118 [15%] preoperative only, 124 [16%] postoperative only, and 127 [16%] both). Hazard-function methodology was used to characterize time-related occurrence of brain metastases and risk factors. Inferences were confirmed by propensity analysis. Results: Twenty-nine patients developed brain metastases, 20 within 1 year; 6 had undergone surgery alone, and 23 had adjuvant therapy. Prevalence was 2.5% 5 years after surgery alone, but 8.4%, 7.0%, and 18.4% after preoperative adjuvant therapy only, postoperative adjuvant therapy only, and both, respectively (p < 0.0001). Greater number of locoregional lymph node metastases was associated with brain metastases after surgery alone (p = 0.04). Distant metastases (p = 0.03) and both preoperative and postoperative adjuvant therapy (p = 0.004) were risk factors. Median survival after diagnosis of brain metastases was 3.5 months. Postesophagectomy propensity-matched survival was shorter after adjuvant therapy than after surgery alone; thus, time available for developing brain metastases after surgery alone was slightly lower. Conclusions: A dose-related increased incidence of brain metastases after adjuvant therapy for esophageal cancer cannot be explained by increased longevity. Adjuvant therapy itself, not just advanced disease, appears to create conditions conducive to developing these rapidly fatal metastases. [Copyright &y& Elsevier]
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- 2006
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35. Pharmacokinetic-Guided Therapeutic Dose Monitoring (TDM) of Busulfan Reduces Relapse of Non-Hodgkin Lymphoma (NHL) Patients Undergoing Autologous Stem Cell Transplantation (ASCT).
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Hill, Brian T., Rybicki, Lisa, Urban, Theresa A., Lucerna, Mariana, Jagadeesh, Deepa, Gerds, Aaron T., Dean, Robert M., Sobecks, Ronald M., Pohlman, Brad, Bolwell, Brian, Kalaycio, Matt E., Hamilton, Betty K., Copelan, Edward A., and Majhail, Navneet S.
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BUSULFAN , *LYMPHOMA treatment , *CANCER relapse , *STEM cell transplantation , *DRUG dosage , *PHARMACOKINETICS - Abstract
Introduction Busulfan (Bu) is integral to many preparative regimens for hematopoietic stem cell transplantation but its metabolism is variable and unpredictable. At our institution, Bu was administered with fixed weight-based dosing (WBD) for NHL patients (pts) undergoing ASCT until 2014 when we initiated a prospective clinical trial (NCT01959477) with pharmacokinetic (PK)-guided therapeutic dose monitoring (TDM) of Bu with cyclophosphamide (Cy) and etoposide (VP16). We subsequently adopted this practice as a standard for all NHL pts. Here, we compare outcomes of NHL pts who received ASCT with WBD vs. PK-directed TDM. Methods We collected clinical features and outcomes of 336 adult NHL pts who underwent ASCT with Bu/Cy/VP16 using WBD (n=258) from 1/2007-12/2013 or TDM from 5/2014-12/2017 (n=78) excluding mantle cell lymphoma. For WBD, Bu was given at 2.8 mg/kg q24 hours on day -9 to -6. For TDM, plasma Bu concentration was serially determined via an in-house liquid chromatography–tandem mass spectrometry (LC–MS/MS) assay as previously described and externally validated. Bu area under the curve (AUC) after first dose was calculated for each pt and used to adjust subsequent doses to target a daily AUC of 4500 μM-minute. Results Baseline features of WBD and TDM pts were similar, although more TDM pts received plerixafor for stem cell mobilization and TDM pts were more often categorized as having a complete remission (CR) prior to ASCT (Table), likely due to more use of PET scan. To adjust for differences, propensity-matched cohorts of WBD and TDM pts were also studied (Table). 36% of TDM pts had increases and 41% had decreases in Bu dose. As shown in the Figure, 24 months after ASCT, relapse was significantly lower with TDM vs. WBD (19% vs. 38%, P = 0.004) and relapse-free survival (RFS) was also improved (69% vs. 55%, P = 0.038). Overall survival (OS) did not differ between WBD and TDM cohorts, likely due to subsequent therapy at the time of relapse. Propensity matched cohorts displayed similar patterns of outcomes. For pts in CR at time of ASCT, RFS did not differ between WBD and TDM (P = 0.79) whereas RFS was improved for pts in
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- 2019
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36. Conditional Survival in Patients with Multiple Myeloma Undergoing Upfront Autologous Stem Cell Transplantation.
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Chakraborty, Rajshekhar, Rybicki, Lisa, Anwer, Faiz, Dean, Robert M., Hamilton, Betty K., Jagadeesh, Deepa, Kalaycio, Matt E., Sobecks, Ronald M., Valent, Jason, and Majhail, Navneet S.
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MULTIPLE myeloma treatment , *AUTOGRAFTS , *HEMATOPOIETIC stem cell transplantation , *CANCER relapse , *CONFIDENCE intervals - Abstract
Background Conditional survival (CS) is defined as the probability of surviving an additional x years given a patient has already survived y years since diagnosis or a time-point of interest. Although there are readily available overall survival (OS) estimates in multiple myeloma (MM) from the time of diagnosis or autologous stem cell transplantation (ASCT), data on CS in those who had already survived a landmark time since ASCT are lacking. Our objective was to investigate 5-year CS rate and standardized mortality ratio (SMR) in 1-, 3- and 5-year survivors after front-line ASCT in MM. Method We reviewed the institutional transplant database at Cleveland Clinic to identify 340 patients who underwent frontline ASCT (≤18 months from diagnosis) for MM between 1996 and 2013. OS was estimated by the Kaplan-Meier method. Relapse mortality (RM) and non-relapse mortality (NRM) were estimated with cumulative incidence. SMR was defined as the ratio of number of deaths in the study patients to that in an age, sex and race-matched healthy population. Estimates of outcomes and SMR are presented with 95% confidence intervals (CI). Results We identified 309 survivors at 1 year, 246 at 3 years, and 178 at 5 years from ASCT. The median age at ASCT was 56 years (range, 22-76) in all 3 cohorts. The median time from diagnosis to ASCT was 7.9 months in 1- and 3-year and 8.2 months in 5-year survivors. Approximately 40%, 35%, and 25% of patients had ISS stage I, II and III disease respectively at diagnosis in all cohorts. Median follow-up from ASCT in surviving patients was 88 months, 90 months and 100 months in 1-, 3- and 5-year survivors respectively. Estimated 5-year CS was 59% (53-64) in 1-year survivors, 60% (53-67) in 3-year survivors and 62% (53-70) in 5-year survivors. The respective cumulative incidence of 5-year conditional RM was 34% (28-39), 29% (23-35) and 25% (18-33) and that of NRM was 7% (5-11), 11% (7-16) and 13% (8-19). The SMR of 1-year, 3-year and 5-year survivors was 6.9 (5.8-8.2), 6.1 (5.0-7.5) and 5.6 (4.3-7.3) respectively, indicating significantly worse survival compared to demographically-matched healthy population irrespective of the duration of survival after ASCT. Survival curves for the 3 cohorts are shown in Figure I. Conclusion The probability of surviving an additional 5 years in patients with MM undergoing front-line ASCT does not improve with time, as shown in 1-, 3- and 5-year survivors, with estimated 5-year CS staying constant at around 60%. However, a decrease in the magnitude of SMR was observed with increase in the number of years already survived after ASCT. Information on CS and SMR is a pragmatic resource for long-term survivorship and beneficial at an individual level for counselling patients. [ABSTRACT FROM AUTHOR]
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- 2019
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37. 200 - Impact of MHC Class I Chain-Related Gene a (MICA) Mismatch on Umbilical Cord Blood Hematopoietic Cell Transplantation.
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Patel, Sagar S., Rybicki, Lisa, Yurch, Melissa, Thomas, Dawn, Jagadeesh, Deepa, Dean, Robert M., Liu, Hein, Flagg, Aron, Cober, Eric, Mossad, Sherif B., Gerds, Aaron T., Hill, Brian T., Hanna, Rabi, Hamilton, Betty K., Pohlman, Brad, Kalaycio, Matt E., Bolwell, Brian, Zhang, Aiwen, Majhail, Navneet S., and Askar, Medhat
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- 2018
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38. 356 - Propensity Matched Analysis of Autologous Hematopoietic Stem Cell Transplantation Outcomes in Solid Organ Transplant Recipients.
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Patel, Sagar S., Rybicki, Lisa, Corrigan, Donna, Jagadeesh, Deepa, Dean, Robert M., Liu, Hein, Flagg, Aron, Gerds, Aaron T., Hill, Brian T., Hanna, Rabi, Bolwell, Brian, Pohlman, Brad, Kalaycio, Matt E., Sobecks, Ronald M., Majhail, Navneet S., and Hamilton, Betty K.
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- 2018
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39. 357 - Complication Rates and Resource Utilization in the First 100 Days Following Allogeneic Hematopoietic Cell Transplantation (Allo HCT) Using Related Haploidentical Donors (Haplo) or Umbilical Cord Blood (UCB).
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El-Asmar, Jessica, Rybicki, Lisa, Bernhard, Laura, Coffman, Julie, Corrigan, Donna, Dean, Robert M., Gerds, Aaron T., Hamilton, Betty K., Hill, Brian T., Jagadeesh, Deepa, Kalaycio, Matt E., Liu, Hien, Pohlman, Brad, Serafino, Sheila, Urban, Theresa A., Sobecks, Ronald M., and Majhail, Navneet S.
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- 2018
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40. 514 - Impact of MHC Class I Chain-Related Gene a (MICA) Mismatch on Haploidentical Hematopoietic Cell Transplantation Outcomes.
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Patel, Sagar S., Rybicki, Lisa, Yurch, Melissa, Thomas, Dawn, Jagadeesh, Deepa, Dean, Robert M., Liu, Hein, Flagg, Aron, Gerds, Aaron T., Hill, Brian T., Hanna, Rabi, Hamilton, Betty K., Pohlman, Brad, Kalaycio, Matt E., Bolwell, Brian, Zhang, Aiwen, Majhail, Navneet S., Askar, Medhat, and Sobecks, Ronald M.
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- 2018
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41. Efficacy of Standard Dose R-CHOP Alternating With R-HDAC Followed by Autologous Hematopoietic Cell Transplantation as Initial Therapy of Mantle Cell Lymphoma, a Single-Institution Experience.
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Sawalha, Yazeed, Hill, Brian T., Rybicki, Lisa A., Sun, Danyu, Dean, Robert M., Jagadeesh, Deepa, Hamilton, Betty K., Gerds, Aaron T., Sobecks, Ronald M., Andresen, Steven, Liu, Hien K., Majhail, Navneet S., Pohlman, Brad, Kalaycio, Matt E., Bolwell, Brian J., and Smith, Mitchell R.
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- 2018
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42. Quality-of-Life Trajectories in Adolescent and Young Adult versus Older Adult Allogeneic Hematopoietic Cell Transplantation Recipients.
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Mathanda, Reema R., Hamilton, Betty K., Rybicki, Lisa, Advani, Anjali S., Colver, Amy, Dabney, Jane, Ferraro, Christina, Hanna, Rabi, Kalaycio, Matt, Lawrence, Christine, McLellan, Linda, Sobecks, Ronald, Majhail, Navneet S., and Rotz, Seth J.
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OLDER people , *CELL transplantation , *AGE differences , *PEOPLE with disabilities , *QUALITY of life , *YOUNG adults , *AGE groups - Abstract
• Adolescent and young adults (AYAs) had comparable quality of life (QoL) compared to older adults during the hematopoietic cell transplantation period. • AYAs have improved QoL over time, during transplant, since 2003. • Improvements in AYA QoL are driven by a domain that mainly addressed psychosocial concerns. Hematopoietic cell transplantation (HCT) is physically and psychologically challenging, potentially exposing patients to quality-of-life (QoL) impairments. Adolescent and young adults (AYAs, aged 15 to 39 years) are a vulnerable cohort facing multiple hurdles due to dynamic changes in several aspects of their lives. The AYA population may be particularly prone to QoL issues during HCT. We hypothesized that due to the unique psychosocial challenges faced by AYAs, they would have an inferior quality of life. We studied QoL differences between AYA (aged 15 to 39 years) and older adult (aged 40 to 60 years) allogeneic HCT recipients before and after HCT. Additionally, we determined if pre-HCT QoL for AYA transplant recipients changed over time. QoL data were collected prospectively before and after transplant on 431 recipients aged 15 to 60 years from June 2003 through December 2017 using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) questionnaire. Repeated-measures analysis of variance was used to assess differences among age groups. Pearson correlation (r) was used to determine if baseline QoL had improved after HCT from June 2003 through December 2017 in the AYA cohort. QoL did not differ among younger AYAs, older AYAs, or older adults at any time in the first year after allogeneic HCT. At 1 year post-HCT, total FACT-BMT score and all FACT-BMT domains except physical well-being improved from pre-HCT in all age groups. From 2003 to 2017, AYA allogeneic recipients experienced modest improvement in additional concerns (r = 0.26, P =.003), trial outcome index (r = 0.23, P =.008), and total FACT-BMT score (r = 0.19, P =.031), although no improvements were seen in physical, social, emotional, or functional well-being. Contrary to our hypothesis, we found that QoL in the AYA population is similar to that of older adults before and after HCT. Improvements in QoL of AYA allogeneic patients since 2003 were driven by the additional concerns domain, which addresses multiple psychosocial aspects such as vocation, hobbies, and acceptance of illness. Continued efforts to tailor treatment and support for AYA HCT recipients is critical to improving QoL outcomes. [ABSTRACT FROM AUTHOR]
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- 2020
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43. 9 - Association of Socioeconomic Status (SES) with Chronic Graft-Versus-Host Disease (cGVHD) Outcomes.
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Hamilton, Betty Ky, Rybicki, Lisa, Arora, Mukta, Arai, Sally, Cutler, Corey S., Flowers, Mary E., Martin, Paul J., Palmer, Jeanne, Pidala, Joseph A., Majhail, Navneet S., Lee, Stephanie J., and Khera, Nandita
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GRAFT versus host disease , *COMPLICATIONS from organ transplantation , *MEDICAL care costs , *SOCIAL status , *SYMPTOMS , *PATIENTS - Published
- 2017
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44. P013 The Effects of Music Therapy in Liquid and Solid Tumor Oncology Patients.
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Bates, Debbie and Rybicki, Lisa
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MUSIC therapy , *TUMOR treatment , *TUMORS , *MEDICAL decision making , *MEDICAL care , *PATIENTS - Published
- 2016
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45. Symptom Clusters and Prognosis in Advanced Cancer (414-B)
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Aktas, Aynur, Rybicki, Lisa, Walsh, Declan, and Schleckman, Ellen
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- 2011
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46. Importance of residual primary cancer after induction therapy for esophageal adenocarcinoma.
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Raja, Siva, Rice, Thomas W., Ehrlinger, John, Goldblum, John R., Rybicki, Lisa A., Murthy, Sudish C., Adelstein, David, Videtic, Gregory, McNamara, Michael P., and Blackstone, Eugene H.
- Abstract
Objectives To (1) assess the continuous distribution of the percentage of residual primary cancer in resection specimens after induction therapy for locally advanced esophageal adenocarcinoma, (2) determine the effects of residual primary cancer on survival after esophagectomy, (3) ascertain interplay between residual primary cancer and classical classifications of response to induction therapy (ypTNM), and (4) identify predictors of residual primary cancer. Methods From January 2006 to November 2012, 188 patients (78%) underwent accelerated chemoradiotherapy, and 52 patients (22%) underwent chemotherapy alone followed by esophagectomy for adenocarcinoma. Mean age was 61 ± 9.2 years, and 89% were male. Residual primary cancer, assessed as the percentage of residual primary cancer cells in resection specimens, was quantified histologically by a gastrointestinal pathologist. Random Forest technology was used for data analysis. Results Twenty-five specimens (10%) had no residual primary cancer (ypT0), 79 (33%) had 1% to 25% residual cancer, 91 (38%) had 26% to 75%, and 45 (19%) had >75%. Survival was worse with increasing residual primary cancer, plateauing at 75%. Greater residual primary cancer was associated with worse survival across the spectrum of higher ypTN. Higher ypT, larger number of positive nodes, and use of induction chemotherapy rather than induction chemoradiotherapy were associated with greater residual primary cancer. Conclusions Less residual primary cancer in response to preoperative therapy is associated with a linear increase in survival after esophagectomy for locally advanced esophageal adenocarcinoma; however, survival is poorer than for resected early-stage cancers. Therefore, for patients with poor prognostic indicators, including higher percentage of residual primary cancer, the role of adjuvant therapy needs to be further examined in an attempt to improve survival. [ABSTRACT FROM AUTHOR]
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- 2016
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47. Durable Long-Term Remission with Allogeneic Hematopoietic Cell Transplantation (HCT) for Relapsed/Refractory Follicular Lymphoma (FL).
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Jagadeesh, Deepa, Rybicki, Lisa, Abounader, Donna, Dean, Robert M., Hill, Brian, Liu, Hien, Sobecks, Ronald M., Hamilton, Betty Ky, Gerds, Aaron, Ferraro, Christina, Starn, Jamie, Winslow, Victoria, Pohlman, Brad, Kalaycio, Matt E., Bolwell, Brian, and Majhail, Navneet S.
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GRAFT versus host disease , *STEM cell transplantation , *DISEASE remission , *HEMATOPOIESIS , *DISEASE relapse , *MEDICAL research - Published
- 2016
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48. Autologous Stem Cell Transplantation (ASCT) Is Effective Therapy for Older Patients with Non-Hodgkin's Lymphoma (NHL).
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Jagadeesh, Deepa, Rybicki, Lisa, Abounader, Donna, Liu, Hein, Dean, Robert M., Hill, Brian T., Sobecks, Ronald M., Gerds, Aaron, Hamilton, Betty Ky, Pohlman, Brad, Kalaycio, Matt E., Bolwell, Brian, and Majhail, Navneet S.
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LYMPHOMA treatment , *STEM cell transplantation , *TREATMENT effectiveness , *AUTOTRANSPLANTATION , *GERIATRIC oncology , *MEDICAL research - Published
- 2016
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49. Allogeneic Hematopoietic Cell Transplantation (HCT) for Adult T-Cell Acute Lymphoblastic Leukemia (T-ALL).
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Hamilton, Betty Ky, Rybicki, Lisa, Advani, Anjali S., Abounader, Donna, Vu, Khoan, Romee, Rizwan, Zeichner, Simon B., Flowers, Christopher, Brown, Stacey, Bashey, Asad, Viswabandya, Auro, Kim, Dennis (Dong Hwan), Wall, Sarah, Devine, Steven M., Sandhu, Karamjeet S., Bachanova, Veronika, McGuirk, Joseph, Ganguly, Siddhartha, Adekola, Kehinde, and Mehta, Jayesh
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HEMATOPOIETIC stem cell transplantation , *HOMOGRAFTS , *T-cell lymphoma , *LYMPHOBLASTIC leukemia treatment , *LYMPHOBLASTIC leukemia , *DISEASES in older people , *PATIENTS - Published
- 2016
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50. Graft-Versus-Host Disease-Free, Relapse-Free Survival (GRFS) after Reduced Intensity Allogeneic Hematopoietic Stem Cell Transplant (HCT) in Older Patients with Myeloid Malignancies.
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Nazha, Aziz, Rybicki, Lisa, Abounader, Donna, Bolwell, Brian, Dean, Robert M., Ferraro, Christina, Gerds, Aaron, Jagadeesh, Deepa, Hamilton, Betty Ky, Hill, Brian T., Kalaycio, Matt E., Liu, Hein, Pohlman, Brad, Sobecks, Ronald M., Starn, Jamie, Winslow, Victoria, Sekeres, Mikkael, and Majhail, Navneet S.
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GRAFT versus host disease , *PROGRESSION-free survival , *HEMATOPOIETIC stem cell transplantation , *HOMOGRAFTS , *LEUKEMIA treatment , *MYELOID leukemia , *CANCER relapse , *OLDER patients - Published
- 2016
- Full Text
- View/download PDF
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