22 results on '"Pohlman, Brad"'
Search Results
2. Late occurrence of progressive multifocal leukoencephalopathy after anti‐CD19 chimeric antigen receptor T‐cell therapy.
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Mian, Agrima, Andrapalliyal, Nirmal, Weathers, Allison L., Pohlman, Brad, and Hill, Brian T.
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PROGRESSIVE multifocal leukoencephalopathy ,CHIMERIC antigen receptors ,JOHN Cunningham virus ,CENTRAL nervous system infections ,LYMPHOMAS ,STEM cell transplantation - Abstract
Progressive multifocal leukoencephalopathy (PML) is a life‐threatening infection of the central nervous system in immunocompromised patients, with an established predilection in non‐Hodgkin's lymphoma and stem cell transplant recipients. In the era of chimeric antigen receptor T‐cell therapy (CAR T‐cell), the occurrence of new‐onset neurological symptoms and encephalopathy in this patient population can be attributed to a variety of factors, including therapy‐related neurotoxicity or disease progression. PML has not been implicated as a common cause of encephalopathy in CAR T‐cell therapy recipients, and the identification of such rare infections is important to guide prognosis and treatment decisions. We hereby report the first case of late occurrence of PML, over one year after CAR T‐cell therapy, for a patient with relapsed large B‐cell lymphoma. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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3. Body mass index does not impact hematopoietic progenitor cell mobilization for autologous hematopoietic cell transplantation.
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Khouri, Jack, Rybicki, Lisa, Majhail, Navneet S., Kalaycio, Matt, Pohlman, Brad, Hill, Brian, Jagadeesh, Deepa, Dean, Robert, Hamilton, Betty, Sobecks, Ronald, Koo, Anna, and Liu, Hien
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BODY mass index ,CELL transplantation ,PROGENITOR cells ,HODGKIN'S disease ,MULTIPLE myeloma - Abstract
Background: Obesity has implications for hematopoietic progenitor cell (HPC) mobilization, chemotherapy administration, and medication dosing. We analyzed the impact of obesity on HPC mobilization as well as key outcomes that are associated with cell dose in autologous hematopoietic cell transplantation (AHCT) recipients. Methods: We conducted a retrospective cohort study on 556 consecutive eligible AHCT recipients at our institution from 1/2004 to 12/2009. Patients were categorized into four groups based on the body mass index (BMI): underweight (BMI < 18.5), normal (18.5‐24.9), overweight (25.0‐29.9), or obese (≥30.0). Primary endpoints of interest included HPC mobilization, neutrophil and platelet recovery, hospital stay and survival. Results: The diagnoses were mostly non‐Hodgkin lymphoma, multiple myeloma, and Hodgkin lymphoma. The majority of the patients had received three or less prior chemotherapy regimens and had not received prior radiation therapy. Most patients had chemosensitive disease at time of transplant. For HPC mobilization regimen, 68% received chemotherapy and G‐CSF, 32% received G‐CSF alone. Busuflan/etoposide/cyclophosphamide, melphalan, and busulfan/cyclophosphamide were used for conditioning. Obesity did not correlate with HPC mobilization and had no association with neutrophil or platelet recovery, or length of transplant hospitalization. On multivariable analysis, obese patients demonstrated better survival than those who were not obese. Conclusion: Obese AHCT recipients had similar rates of HPC mobilization, neutrophil and platelet engraftment and length of transplant hospitalization, and experienced better survival compared with recipients with lower BMI. High BMI by itself should not be considered as a contraindication to AHCT. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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4. Neutropenic fever during peripheral blood progenitor cell mobilization is associated with decreased CD34+ cell collection and increased apheresis collection days.
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Khouri, Jack, Rybicki, Lisa, Majhail, Navneet, Kalaycio, Matt, Copelan, Edward, Pohlman, Brad, Hill, Brian, Dean, Robert, Lazaryan, Aleksandr, Hamilton, Betty, Andresen, Steven, Sobecks, Ronald, Bolwell, Brian, and Liu, Hien
- Abstract
Abstract: Background: Peripheral blood progenitor cell (PBPC) mobilization with chemotherapy in addition to Granulocyte‐Colony Stimulating Factor (G‐CSF) improves cell collection compared to G‐CSF alone; however, it is associated with increased risk of neutropenic fever (NF). Methods: We analyzed risk factors for post‐priming NF and NF association with autologous stem cell transplant outcomes. Between 1998 and 2008, 593 adult patients with lymphoma underwent PBPC mobilization with etoposide and G‐CSF. Results: Median age was 51 years (range 18–77) and 372 (63%) were male. Diagnoses were 457 (77%) non‐Hodgkin lymphoma and 136 (23%) Hodgkin lymphoma. Of 554 (93%) transplanted patients, majority were in complete or partial remission at time of transplant (88%). Overall, 141 (24%) patients were hospitalized for NF. Nine patients (6%) had bacteremia, 4 (3%) had pneumonia, 2 (<1%) had herpes simplex viral infections, and the remaining 126 (90%) had no identified infection source. NF patients had lower likelihood of proceeding to transplant (86% vs. 96%, P < .001), lower CD34+ cell dose collection (median 7.23 × 106 CD34+ cells/kg vs. 8.98 × 106 CD34+ cells/kg, P = .002), and were more likely to require > 4 days of apheresis (48% vs. 37%, P < .001). NF was associated with a higher 30‐day readmission rate following transplant hospitalization (17% vs. 9%, P = .012). Conclusion: NF during etoposide priming is associated with lower likelihood of proceeding to transplant, lower CD34+ cell dose collection, more apheresis days required for collection and a higher 30‐day readmission rate following transplant discharge. [ABSTRACT FROM AUTHOR]
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- 2018
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5. Impact of comorbidities on outcomes of elderly patients with diffuse large B-cell lymphoma.
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Saygin, Caner, Jia, Xuefei, Hill, Brian, Dean, Robert, Pohlman, Brad, Smith, Mitchell R., and Jagadeesh, Deepa
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- 2017
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6. The association of histologic grade with acute graft-versus-host disease response and outcomes.
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Narkhede, Mayur, Rybicki, Lisa, Abounader, Donna, Bolwell, Brian, Dean, Robert, Gerds, Aaron T., Hanna, Rabi, Hill, Brian, Jagadeesh, Deepa, Kalaycio, Matt, Liu, Hien D., Pohlman, Brad, Sobecks, Ronald, Majhail, Navneet S., and Ky Hamilton, Betty
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- 2017
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7. Dual institution experience of nodal marginal zone lymphoma reveals excellent long-term outcomes in the rituximab era.
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Starr, Adam G., Caimi, Paolo F., Fu, PingFu, Massoud, Mira R., Meyerson, Howard, Hsi, Eric D., Mansur, David B., Cherian, Sheen, Cooper, Brenda W., De Lima, Marcos J. G., Lazarus, Hillard M., Gerson, Stanton L., Jagadeesh, Deepa, Smith, Mitchell R., Dean, Robert M., Pohlman, Brad L., Hill, Brian T., and William, Basem M.
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LYMPHOMAS ,B cell lymphoma ,RITUXIMAB ,LACTATE dehydrogenase ,HEMATOLOGY - Abstract
Nodal marginal zone lymphoma ( NMZL) is a rare non-Hodgkin lymphoma that arises from mature B-cells. We delineate outcomes, prognostic factors and treatment trends among a large cohort of patients with NMZL in the rituximab era. We identified 56 such patients treated at our institutions. The majority presented with advanced stage disease (78·6%). Over a median follow-up of 38·2 months, median progression-free survival ( PFS) was 42·4 months and median overall survival ( OS) was not reached. Kaplan-Meier estimates of OS at 120 months after diagnosis was 71·9%. High-risk follicular lymphoma international prognostic index ( FLIPI) was associated with inferior PFS. Age >60 years and elevated serum lactate dehydrogenase ( LDH) were associated with inferior OS. Transformation to diffuse large B-cell lymphoma occurred in 7 patients, 6 of who presented with advanced disease. OS was comparable to our previously reported extranodal MZL cohort. FLIPI score predicted for inferior PFS and OS when both cohorts were analysed together ( n = 267). In summary, outcomes in NMZL are favourable with a large majority of patients surviving at 120 months. High risk FLIPI, age >60 years, and elevated serum LDH were associated with inferior outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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8. Is rituximab sub-optimally dosed in indolent B cell lymphoma?
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Sawalha, Yazeed, Rouphail, Basel, Jia, Xuefei, Dean, Robert M., Hill, Brian T., Jagadeesh, Deepa, Pohlman, Brad L., and Smith, Mitchell R.
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B cell lymphoma ,LYMPHOMA treatment ,RITUXIMAB ,PHARMACOKINETICS ,CANCER chemotherapy - Abstract
Rituximab pharmacokinetics are affected by gender, age and weight and can affect outcomes in aggressive B cell lymphoma. Less is known about the pharmacokinetics of rituximab in indolent B cell lymphoma ( iNHL). We analysed the effects of gender, age, weight and body surface area on the outcomes of 303 patients treated with first line rituximab-based regimens for iNHL. The patients were divided into 3 treatment cohorts: rituximab only, rituximab + chemotherapy (R- CTX) and R- CTX followed by rituximab maintenance; furthermore, each cohort was subdivided as follicular ( FL) or non- FL, based on histology. Older males and patients with higher weight had worse outcomes when treated with R- CTX, probably due to faster rituximab clearance. Our results concur with studies of R- CTX for DLBCL. As this effect was not observed in patients treated with rituximab alone or R- CTX followed by rituximab maintenance, we hypothesize that higher rituximab levels reached with weekly rituximab and/or prolonged exposure achieved with maintenance therapy exceed the therapeutic threshold, even with faster clearance, which nullifies the negative effect of higher weight and male gender. In conclusion, under current practices, a subset of patients with iNHL, i.e., FL treated with R- CTX, may be sub-optimally dosed with rituximab. [ABSTRACT FROM AUTHOR]
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- 2016
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9. Dual institution experience of extranodal marginal zone lymphoma reveals excellent long-term outcomes.
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Starr, Adam G., Caimi, Paolo F., Fu, PingFu, Massoud, Mira R., Meyerson, Howard, Hsi, Eric D., Mansur, David B., Cherian, Sheen, Singh, Arun D., Cooper, Brenda W., De Lima, Marcos J.G., Lazarus, Hillard M., Gerson, Stanton L., Jagadeesh, Deepa, Smith, Mitchell R., Dean, Robert M., Pohlman, Brad L., Hill, Brian T., and William, Basem M.
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LYMPHOMAS ,HEALTH outcome assessment ,LYMPH node diseases ,B cell lymphoma ,ANTIBIOTICS ,RITUXIMAB ,CANCER chemotherapy - Abstract
Extranodal marginal zone lymphoma ( EMZL) is a B-cell lymphoma arising from mucosa-associated lymphoid tissue (MALT). The disease characteristics, clinical course and treatment vary considerably based on site of involvement. Because long-term outcome data for EMZL are limited, we sought to describe the clinical details of a large number of patients with EMZL evaluated at the Case Comprehensive Cancer Center over a 12-year period to identify prognostic markers including the impact of site of involvement. We identified 211 cases of EMZL involving the stomach (30%), ocular adnexa (19%), lungs (16%) and intestines (9%). Initial treatment included antibiotics (18%), radiation (21%), rituximab (20%), chemotherapy (3%), rituximab + chemotherapy (7%), surgery (17%) or observation (8%). After a median follow-up of 44·3 months (range 2·2-214·9), median progression-free survival ( PFS) was 68·2 months (95% confidence interval [CI] 54·5-111·3) and median overall survival ( OS) has not been reached. Age >60 years, elevated lactate dehydrogenase level ( LDH), ≥4 lymph node groups involvement, and high follicular lymphoma international prognostic index ( FLIPI) were associated with inferior PFS/ OS. In summary, patients with EMZL have excellent prognosis with median OS in excess of 10 years. Age, elevated LDH, advanced disease, and high FLIPI score are associated with worse outcomes. [ABSTRACT FROM AUTHOR]
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- 2016
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10. Early stage, bulky Hodgkin lymphoma patients have a favorable outcome when treated with or without consolidative radiotherapy: potential role of PET scan in treatment planning.
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Nguyen, Van T., Pophali, Priyanka A., Tsai, Judy P., Jagadeesh, Deepa, Dean, Robert M., Pohlman, Brad, Morgan, David S., Greer, John P., Smith, Mitchell R., Hill, Brian T., and Reddy, Nishitha M.
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RADIOTHERAPY ,HODGKIN'S disease treatment ,POSITRON emission tomography ,CANCER chemotherapy ,STEM cell transplantation - Abstract
The article discusses the use of consolidative radiotherapy for treatment of bulky Hodgkin lymphoma patients, and also mentions the role of positron emission tomography (PET) scan in treatment planning. It mentions patient received second line chemotherapy followed by autologous stem cell transplant. It also mentions radiotherapy in patients with bulky disease is safe.
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- 2017
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11. A Phase II trial of Belinostat ( PXD101) in patients with relapsed or refractory peripheral or cutaneous T-cell lymphoma.
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Foss, Francine, Advani, Ranjana, Duvic, Madeleine, Hymes, Kenneth B., Intragumtornchai, Tanin, Lekhakula, Arnuparp, Shpilberg, Ofer, Lerner, Adam, Belt, Robert J., Jacobsen, Eric D., Laurent, Guy, Ben‐Yehuda, Dina, Beylot‐Barry, Marie, Hillen, Uwe, Knoblauch, Poul, Bhat, Gajanan, Chawla, Shanta, Allen, Lee F., and Pohlman, Brad
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T-cell lymphoma ,CANCER relapse ,HISTONE deacetylase inhibitors ,MYCOSIS fungoides ,JUGULAR vein ,CUTANEOUS therapeutics ,NEOVASCULARIZATION inhibitors ,DISEASES ,THERAPEUTICS ,CANCER treatment - Abstract
Belinostat is a pan-histone deacetylase inhibitor with antitumour and anti-angiogenic properties. An open label, multicentre study was conducted in patients with peripheral T-cell lymphoma ( PTCL) or cutaneous T-cell lymphoma ( CTCL) who failed ≥1 prior systemic therapy and were treated with belinostat (1000 mg/m
2 intravenously ×5 d of a 21-d cycle). The primary endpoint was objective response rate ( ORR). Patients with PTCL ( n = 24) had received a median of three prior systemic therapies (range 1-9) and 40% had stage IV disease. Patients with CTCL ( n = 29) had received a median of one prior skin-directed therapy (range 0-4) and four prior systemic therapies (range 1-9); 55% had stage IV disease. The ORRs were 25% ( PTCL) and 14% ( CTCL). Treatment-related adverse events occurred in 77% of patients; nausea (43%), vomiting (21%), infusion site pain (13%) and dizziness (11%) had the highest incidence. Treatment-related serious adverse events were Grade 5 ventricular fibrillation; Grade 4 thrombocytopenia; Grade 3 peripheral oedema, apraxia, paralytic ileus and pneumonitis; and Grade 2 jugular vein thrombosis. Belinostat monotherapy was well tolerated and efficacious in patients with recurrent/refractory PTCL and CTCL. This trial was registered at as NCT00274651. [ABSTRACT FROM AUTHOR]- Published
- 2015
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12. Predicting hematopoietic stem cell mobilization failure in patients with multiple myeloma: A simple method using day 1 CD34+ cell yield.
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Duong, Hien K., Bolwell, Brian J., Rybicki, Lisa, Koo, Anna, Hsi, Eric D., Figueroa, Priscilla, Dean, Robert, Pohlman, Brad, Kalaycio, Matt, Andresen, Steven, Sobecks, Ronald, and Copelan, Edward
- Abstract
Early and reliable prediction of the likelihood of achieving adequate stem cell collection for autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM) would improve collection efficiency, prevent unnecessary aphereses, and permit appropriate treatment alterations. No previous study has reported a threshold CD34+ cell collection quantity on Day 1 or 2 of leukapheresis that could predict successful stem cell collection. We performed a retrospective analysis of all MM patients undergoing first attempt of stem cell collection at our institution from 2001 through 2008. Recursive partitioning analysis was used to identify Day 1 or Day 1+2 CD34+ collection quantity that predicted failure to reach target ≥2 × 10
6 CD34+ cells/kg within five days of collection. Totally, 172 patients were included in the analysis. Patients underwent mobilization with G-CSF or G-CSF+ chemotherapy. 23 of 172 patients (13.4%) failed to collect sufficient (≥2 × 106 CD34+ cells/kg) CD34+ cells after five days of apheresis: 22 of 29 who collected ≤0.70 × 106 CD34+ cells/kg and 1 of 143 who collected >0.70 × 106 CD34+ cells/kg (75.9% vs. 0.7%, P < 0.001) on Day 1. Collection failure occurred in 23 of 30 patients who collected ≤1.54 × 106 CD34+ cells/kg and 0 of 142 who collected >1.54 × 106 CD34+ cells/kg (76.7% vs. 0%, P < 0.001) on Days 1 + 2. Day 1 CD34+ cell collection quantity identifies patients unlikely to achieve adequate collection for ASCT. Patients who collect ≤0.70 × 106 CD34+ cells/kg on day 1 could be considered for treatment modifications to improve CD34+ collection, such as early administration of plerixafor or large volume apheresis. J. Clin. Apheresis, 2011. © 2011 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]- Published
- 2011
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13. Autologous stem cell transplant for early relapsed/refractory Hodgkin lymphoma: results from two transplant centres.
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Smith, Stephen D., Moskowitz, Craig H., Dean, Robert, Pohlman, Brad, Sobecks, Ronald, Copelan, Edward, Andresen, Steven, Bolwell, Brian, Maragulia, Jocelyn C., Vanak, Jill M., Sweetenham, John, and Moskowitz, Alison J.
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HODGKIN'S disease ,DISEASE relapse ,PROGNOSIS ,STEM cell transplantation ,MULTIVARIATE analysis - Abstract
Prior series have demonstrated that early relapsed (within 1 year) or refractory Hodgkin lymphoma (HL) is associated with poor prognosis. To determine the outcome for patients with early relapsed/refractory HL in the modern era, we combined data from two large transplant centres, Cleveland Clinic Taussig Cancer Institute (CCTCI) and Memorial Sloan-Kettering Cancer Center (MSKCC), and analysed consecutive patients transplanted for relapsed/refractory HL following induction failure or remission durations of <1 year. Two hundred and fourteen patients were analysed and the event-free survival (EFS) and overall survival (OS) at 6 years for all patients were 45% and 55%, respectively. Factors significant for prognosis in multivariate analysis were extranodal disease and bulky disease (≥5 cm). Patients with 0, 1, or 2 risk factors achieved 6 year EFS of 65%, 47%, and 24% and 6 year OS of 81%, 55%, and 27%, respectively. Patients with the sole risk factor of early relapsed/refractory disease achieved good outcomes in this large series; however the presence of bulk and/or extranodal disease significantly reduced EFS and OS. Patients with these additional risk factors are best suited for clinical trials investigating novel salvage regimens and post-transplant maintenance strategies. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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14. The non-relapse mortality rate for patients with diffuse large B-cell lymphoma is greater than relapse mortality 8 years after autologous stem cell transplantation and is significantly higher than mortality rates of population controls.
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Hill, Brian T., Rybicki, Lisa, Bolwell, Brian J., Smith, Stephen, Dean, Robert, Kalaycio, Matt, Pohlman, Brad, Tench, Shawnda, Sobecks, Ronald, Andresen, Steven, Copelan, Edward, and Sweetenham, John
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B cells ,LYMPHOMA treatment ,STEM cell transplantation ,DRUG therapy ,MORTALITY - Abstract
High dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the preferred treatment modality for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). To assess long-term outcomes of these patients, we retrospectively analysed data from 309 consecutive patients who underwent ASCT for DLBCL between 1994 and 2006. We found that non-relapse mortality (NRM) became the major cause of death beginning approximately 8 years after ASCT. The most common causes of NRM during the study period were respiratory failure (31%), infection (13%), cardiac toxicity (15%) and secondary malignancy (15%). The strongest predictor of relapse mortality (RM) was disease status at transplant: patients who were in second or greater complete or partial remission had a higher risk of RM than those in first complete or partial remission [hazard ratio (HR) 3·7, P < 0·001], as did those who were relapsed or refractory (HR 4·9, P < 0·001). We describe the longest reported follow-up of a large cohort of DLBCL patients uniformly-treated with ASCT. Although relapse was initially the more likely cause of death, NRM exceeded RM after 8 years. After ASCT, surviving patients have significantly increased risk mortality rates relative to the general population and this excess risk persists over time. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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15. Multiple unit umbilical cord blood transplantation with total body irradiation, etoposide and antithymocyte globulin for adult haematological malignancy patients.
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Sobecks, Ronald M., Copelan, Edward, Kalaycio, Matt, Askar, Medhat, Rybicki, Lisa, Serafino, Sheila, Serafin, Mary, Macklis, Roger, Dean, Robert, Pohlman, Brad, Andresen, Steven, and Bolwell, Brian J.
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BLOOD diseases ,IRRADIATION ,ETOPOSIDE ,GLOBULINS ,CORD blood transplantation ,BONE marrow ,PATIENTS ,THERAPEUTICS - Abstract
The article presents a study regarding the medical case of 16 haemotological malignancy patients. The study uses total body irradiation (TBI), etoposide and antithymocyte globulin (ATG) to conduct multiple unit umbilical cord blood transplantation (MU-UCBT). The result shows that three patients experienced early deaths and one had graft failure but was infused with cryopreserved remission autologous bone marrow and remains alive in complete remission for 1056 days.
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- 2011
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16. Non-mycosis fungoides cutaneous T-cell lymphoma: reclassification according to the WHO-EORTC classification.
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Weaver, Joshua, Mahindra, Anuj Kumar, Pohlman, Brad, Jin, Tao, and Hsi, Eric D.
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T-cell lymphoma ,MYCOSIS fungoides ,CANCER ,THERAPEUTICS - Abstract
Background: Non-mycosis fungoides (non-MF) primary cutaneous T-cell lymphomas (PCTCL) are heterogeneous and divided into subgroups by the World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) classification of cutaneous lymphomas. We report the first North American series to examine the applicability of the classification, compare our findings with the predominant European literature and confirm the significance of separation into the indolent and aggressive groups. Methods: Forty-four non-MF PCTCL cases with available tissue for phenotyping, adequate clinical staging information and follow-up were reclassified according to the WHO-EORTC classification. Results: Non-MF PCTCL had a longer overall survival (OS) (13.8 years) compared with secondary cutaneous T-cell lymphoma (SC-TCL) (2.5 years). Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) had the most favorable outcome (OS 14.1 years), whereas secondary and primary peripheral T-cell lymphoma, unspecified had the shortest OS (2.5 and 2.4 years, respectively). Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma (CTLCD4) appeared to have a favorable course. Conclusions: Most non-MF PCTCL can be classified according to the WHO-EORTC classification. The relative frequencies are similar to European experience. Non-MF PCTCL is a heterogeneous group with a favorable outcome compared to SC-TCL, especially PC-ALCL and CTLCD4. Separation of non-MF PCTCL into indolent and aggressive groups appears clinically significant and may provide direction for therapeutic decisions. Weaver J, Mahindra AK, Pohlman B, Jin T, His ED. Non-mycosis fungoides cutaneous T-cell lymphoma: reclassification according to the WHO-EORTC classification. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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17. Superior survival after replacing oral with intravenous busulfan in autologous stem cell transplantation for non-Hodgkin lymphoma with busulfan, cyclophosphamide and etoposide.
- Author
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Dean, Robert M., Pohlman, Brad, Sweetenham, John W., Sobecks, Ronald M., Kalaycio, Matt E., Smith, Stephen D., Copelan, Edward A., Andresen, Steven, Rybicki, Lisa A., Curtis, Julie, and Bolwell, Brian J.
- Subjects
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AUTOTRANSPLANTATION , *CELL transplantation , *CYCLOPHOSPHAMIDE , *ETOPOSIDE , *PHARMACOKINETICS , *LYMPHOMAS - Abstract
Autologous stem cell transplantation (ASCT) with cyclophosphamide, etoposide and oral busulfan (BuCyVP) is an effective therapy for relapsed or refractory non-Hodgkin lymphoma (NHL). Substituting intravenous for oral busulfan reduces variability in drug exposure, potentially improving the safety and efficacy of the BuCyVP regimen. We retrospectively compared the outcomes of 604 consecutively treated patients who underwent ASCT for NHL with BuCyVP using oral ( n = 468) or IV ( n = 136) busulfan, without measurement of busulfan levels for pharmacokinetic (PK) analysis. Patients who received oral busulfan experienced more severe oral mucositis and a higher incidence of nonrelapse mortality. Median overall survival (OS) after ASCT was 72 months with oral busulfan but was not reached for the IV busulfan group. IV busulfan was associated with a lower rate of relapse, and superior relapse-free survival (RFS) and OS. In multivariate models, the route of busulfan administration was an independent prognostic factor for relapse ( P = 0·01), RFS ( P = 0·002) and OS ( P = 0·001). IV busulfan appears to provide better efficacy and lower toxicity than oral busulfan in ASCT with BuCyVP for NHL. Whether PK-based busulfan dosing can achieve further improvements in this setting is worthy of study. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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18. Elevated pretransplant ferritin is associated with a lower incidence of chronic graft- versus-host disease and inferior survival after myeloablative allogeneic haematopoietic stem cell transplantation.
- Author
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Mahindra, Anuj, Bolwell, Brian, Sobecks, Ronald, Rybicki, Lisa, Pohlman, Brad, Dean, Robert, Andresen, Steve, Sweetenham, John, Kalaycio, Matt, and Copelan, Edward
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FERRITIN ,STEM cell transplantation ,SERUM ,HOMOGRAFTS ,GRAFT versus host disease - Abstract
Elevated pretransplant serum ferritin levels have been associated with an increased incidence of morbidity and mortality after allogeneic haematopoietic stem cell transplantation (HCT). We studied 222 patients who underwent myeloablative allogeneic HCT in whom pretransplantation serum ferritin levels were available. Pretransplantation ferritin > 1910 μg/l was associated with lower overall survival ( P = 0·003), lower relapse-free survival ( P = 0·003), decreased chronic graft- versus-host disease (GVHD) ( P = 0·019) and increased non-relapse mortality (NRM) ( P = 0·042). Similar results were obtained when pretransplantation ferritin was analysed as a continuous variable and by quartiles. Our results indicate that an elevated pretransplant ferritin level adversely impacts transplantation outcomes. The adverse impact of elevated ferritin on NRM and survival was despite its association with lower incidences of acute and chronic GVHD, which are major causes of NRM. The association of ferritin with iron overload and its influence on HCT outcomes requires further prospective validation. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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19. Timed sequential induction chemotherapy and risk-adapted postremission therapy for acute myelogenous leukemia.
- Author
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Kalaycio, Matt, Advani, Anjali, Pohlman, Brad, Sekeres, Mikkael, Tripp, Barbara, Rybicki, Lisa, and Sobecks, Ronald
- Published
- 2008
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20. High-dose busulfan and the risk of pulmonary mortality after autologous stem cell transplant.
- Author
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Kalaycio, Matt, Pohlman, Brad, Kuczkowski, Elizabeth, Rybicki, Lisa, Andresen, Steve, Sobecks, Ronald, and Bolwell, Brian
- Subjects
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STEM cell transplantation , *HODGKIN'S disease , *DRUG therapy , *AUTOTRANSFUSION of blood , *PULMONARY toxicology , *MORTALITY , *DRUG administration - Abstract
The non-relapse mortality of autologous stem cell transplant is low enough that the procedure has been extended to older patients with non-Hodgkin's lymphoma. We treated 537 non-Hodgkin's lymphoma patients with high-dose chemotherapy consisting of busulfan, cyclophosphamide, and etoposide followed by autologous stem cell transplant. Sixteen patients were identified who died of pulmonary complications at a five-year incidence of 3.6%. Risk factors for pulmonary mortality included older age and lower baseline DCO and FEV1. We conclude that high-dose busulfan is associated with pulmonary mortality after autologous transplant, particularly in older patients. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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21. Validation of the mantle cell lymphoma international prognostic index: A single-center retrospective analysis.
- Author
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Smith, Stephen D., Hsi, Eric, Bolwell, Brian, Pohlman, Brad, Dean, Robert, Effinger, Meagan, Maggiotto, Amanda, and Sweetenham, John
- Published
- 2010
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22. Early infectious complications after autologous hematopoietic cell transplantation for multiple myeloma.
- Author
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Rahman, Shafia, Rybicki, Lisa, Ky Hamilton, Betty, Pohlman, Brad, Jagadeesh, Deepa, Cober, Eric, Kalaycio, Matt, Dean, Robert, Sobecks, Ronald, Mossad, Sherif B., and Majhail, Navneet S.
- Subjects
CELL transplantation ,MULTIPLE myeloma ,CLOSTRIDIOIDES difficile ,FEBRILE neutropenia ,HEMATOPOIETIC stem cell transplantation ,REVERSE genetics ,COLITIS - Abstract
Background: The spectrum of infectious complications in autologous hematopoietic cell transplant recipients (AHCT) with multiple myeloma has not been well described in the recent era of novel agent induction and improved supportive care. Methods: We conducted a retrospective cohort study of 413 adult myeloma AHCT recipients at our institution from 2007‐2016 to describe the cumulative incidence and risk factors for various infections and FN occurring within the first 100 days after AHCT. Additionally, landmark analysis was done among 404 patients who survived at least 100 days after transplant admission to estimate the association of infections with subsequent non‐relapse mortality (NRM), overall survival (OS), and relapse‐free survival (RFS). Results: Cumulative incidences (95% CI) of infection events by day 100 were: FN 43% (38‐48), any infection 21% (17‐25), bacterial 17% (14‐21), viral 4% (3‐7) and fungal 1% (0.5‐3), central line‐associated blood stream infection 3% (2‐6), and Clostridium difficile colitis 6% (4‐8). Patients with infection had a longer initial transplant hospitalization (median 17 vs 16 days, P < 0.01), more readmissions (31% vs 8%, P < 0.01), and spent more days in hospital in first 100 days (median 18 vs 16 days, P < 0.01). A 100‐day mortality was low and similar between groups (2% vs 1%, P = 0.28). In landmark analysis of 404 100‐day survivors, OS was worse among patients with early infections (hazard ratio 1.54 [1.03‐2.30], P = 0.03), although there was no difference in NRM and RFS. Conclusions: Notwithstanding advances in supportive care, early infectious complications remain a relevant source of morbidity and require attention in myeloma AHCT recipients. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
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