296 results on '"Adam J. Olszewski"'
Search Results
2. Impact of early relapse within 24 months after first-line systemic therapy (POD24) on outcomes in patients with marginal zone lymphoma: A US multisite study
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Narendranath Epperla, Rina Li Welkie, Pallawi Torka, Geoffrey Shouse, Reem Karmali, Lauren Shea, Andrea Anampa-Guzmán, Timothy S. Oh, Heather Reaves, Montreh Tavakkoli, Kathryn Lindsey, Irl Brian Greenwell, Emily Hansinger, Colin Thomas, Sayan Mullick Chowdhury, Kaitlin Annunzio, Beth Christian, Stefan K. Barta, Praveen Ramakrishnan Geethakumari, Nancy L. Bartlett, Alex F. Herrera, Natalie S. Grover, and Adam J. Olszewski
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POD24 ,Non-POD24 ,Marginal zone lymphoma ,Overall survival ,Diseases of the blood and blood-forming organs ,RC633-647.5 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Progression of disease within 24 months (POD24) from diagnosis in marginal zone lymphoma (MZL) was shown to portend poor outcomes in prior studies. However, many patients with MZL do not require immediate therapy, and the time from diagnosis-to-treatment interval can be highly variable with no universal criteria to initiate systemic therapy. Hence, we sought to evaluate the prognostic relevance of early relapse or progression within 24 months from systemic therapy initiation in a large US cohort. The primary objective was to evaluate the overall survival (OS) in the two groups. The secondary objective included the evaluation of factors predictive of POD24 and the assessment of cumulative incidence of histologic transformation (HT) in POD24 versus non-POD24 groups. The study included 524 patients with 143 (27%) in POD24 and 381 (73%) in non-POD24 groups. Patients with POD24 had inferior OS compared to those without POD24, regardless of the type of systemic therapy received (rituximab monotherapy or immunochemotherapy) at diagnosis. After adjusting for factors associated with inferior OS in the univariate Cox model, POD24 remained associated with significantly inferior OS (HR = 2.50, 95% CI = 1.53–4.09, p = 0.0003) in multivariable analysis. The presence of monoclonal protein at diagnosis and those who received first-line rituximab monotherapy had higher odds of POD24 on logistic regression analysis. Patients with POD24 had a significantly higher risk for HT compared to those without POD24. POD24 in MZL might be associated with adverse biology and could be used as an additional information point in clinical trials and investigated as a marker for worse prognosis.
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- 2023
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3. Clinical activity of 9-ING-41, a small molecule selective glycogen synthase kinase-3 beta (GSK-3β) inhibitor, in refractory adult T-Cell leukemia/lymphoma
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Andrew Hsu, Kelsey E. Huntington, Andre De Souza, Lanlan Zhou, Adam J. Olszewski, Nirav P. Makwana, Diana O. Treaba, Ludimila Cavalcante, Francis J. Giles, Howard Safran, Wafik S. El-Deiry, and Benedito A. Carneiro
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atll ,gsk-3 ,gsk-3b ,9-ing-41 ,glycogen synthase kinase 3 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
GSK-3β is a serine/threonine kinase implicated in tumorigenesis and chemotherapy resistance. GSK-3β blockade downregulates the NF-κB pathway, modulates immune cell PD-1 and tumor cell PD-L1 expression, and increases CD8 + T cell and NK cell function. We report a case of adult T-cell leukemia/lymphoma (ATLL) treated with 9-ING-41, a selective GSK-3β inhibitor in clinical development, who achieved a durable response. A 43-year-old male developed diffuse lymphadenopathy, and biopsy of axillary lymph node showed acute-type ATLL. Peripheral blood flow cytometry revealed a circulating clonal T cell population, and CSF was positive for ATLL involvement. After disease progression on the 3rd line of treatment, he started treatment with 9-ING-41 monotherapy in a clinical trial (NCT03678883). CT imaging after seven months showed a partial response. Sustained reduction of peripheral blood ATLL cells lasted 15 months. Treatment of patient-derived CD8 + T cells with 9-ING-41 increased the secretion of IFN-γ, granzyme B, and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL). In conclusion, treatment of a patient with refractory ATLL with the GSK-3β inhibitor 9-ING-41 resulted in a prolonged response. Ongoing experiments are investigating the hypothesis that 9-ING-41-induced T cell activation and immunomodulation contributes to its clinical activity. Further clinical investigation of 9-ING-41 for treatment of ATLL is warranted.
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- 2022
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4. Predictive factors and outcomes for ibrutinib in relapsed/refractory marginal zone lymphoma: a multicenter cohort study
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Narendranath Epperla, Qiuhong Zhao, Sayan Mullick Chowdhury, Lauren Shea, Tamara K. Moyo, Nishitha Reddy, Julia Sheets, David M. Weiner, Praveen Ramakrishnan Geethakumari, Malathi Kandarpa, Ximena Jordan Bruno, Colin Thomas, Michael C. Churnetski, Andrew Hsu, Luke Zurbriggen, Cherie Tan, Kathryn Lindsey, Joseph Maakaron, Paolo F. Caimi, Pallawi Torka, Celeste Bello, Sabarish Ayyappan, Reem Karmali, Seo-Hyun Kim, Anna Kress, Shalin Kothari, Yazeed Sawalha, Beth Christian, Kevin A. David, Irl Brian Greenwell, Murali Janakiram, Vaishalee P. Kenkre, Adam J. Olszewski, Jonathon B. Cohen, Neil Palmisiano, Elvira Umyarova, Ryan A. Wilcox, Farrukh T. Awan, Juan Pablo Alderuccio, Stefan K. Barta, Natalie S. Grover, Nilanjan Ghosh, Nancy L. Bartlett, Alex F. Herrera, and Geoffrey Shouse
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Marginal zone lymphoma ,MZL ,Ibrutinib ,Relapsed ,Refractory ,Diseases of the blood and blood-forming organs ,RC633-647.5 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Ibrutinib is effective in the treatment of relapsed/refractory (R/R) marginal zone lymphoma (MZL) with an overall response rate (ORR) of 48%. However, factors associated with response (or lack thereof) to ibrutinib in R/R MZL in clinical practice are largely unknown. To answer this question, we performed a multicenter (25 US centers) cohort study and divided the study population into three groups: “ibrutinib responders”—patients who achieved complete or partial response (CR/PR) to ibrutinib; “stable disease (SD)”; and “primary progressors (PP)”—patients with progression of disease as their best response to ibrutinib. One hundred and nineteen patients met the eligibility criteria with 58%/17% ORR/CR, 29% with SD, and 13% with PP. The median PFS and OS were 29 and 71.4 months, respectively, with no difference in PFS or OS based on the ibrutinib line of therapy or type of therapy before ibrutinib. Patients with complex cytogenetics had an inferior PFS (HR = 3.08, 95% CI 1.23–7.67, p = 0.02), while those with both complex cytogenetics (HR = 3.00, 95% CI 1.03–8.68, p = 0.04) and PP (HR = 13.94, 95% CI 5.17–37.62, p
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- 2022
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5. Use of bone‐modifying agents and clinical outcomes in older adults with multiple myeloma
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Adam J. Olszewski, Peter M. Barth, and John L. Reagan
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bisphosphonates ,bone‐modifying agents ,health services research ,multiple myeloma ,SEER‐Medicare ,supportive care ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Guidelines recommend bone‐modifying agents (BMAs) for all patients initiating treatment for myeloma. We examined adherence to this recommendation, and BMA effectiveness in the era of bortezomib/lenalidomide‐based therapy among Medicare beneficiaries. Methods From the linked Surveillance, Epidemiology, and End Results‐Medicare registry, we selected beneficiaries receiving anti‐myeloma chemotherapy in 2007‐2013. We matched BMA recipients (within 90 days of first chemotherapy) to nonrecipients using a propensity score, balancing patient‐, disease‐, and therapy‐related confounders. Cumulative incidence of skeletal‐related events (SREs) and overall survival (OS) was compared in proportional hazard models accounting for competing risks and immortal‐time bias. Results Among 4611 patients with median age of 76 years, 51% received BMA. Bone‐modifying agents use remained steady over time (P = .87) and was significantly less frequent for patients who were older, with comorbidities, without prior SRE, and those treated without bortezomib or lenalidomide. In a propensity score‐matched cohort, BMA recipients experienced a lower incidence of SRE (11.0% vs 14.6% at 3 years; subhazard ratio, 0.73; 95% CI, 0.60‐0.89) and better OS (53.3% vs 47.8% at 3 years; hazard ratio, 0.86; 95% CI, 0.77‐0.95). The results were consistent in the subgroup (76%) treated with bortezomib and/or immunomodulatory drugs (IMiDs). The incidence of osteonecrosis of the jaw (ONJ) was 3.2% at 3 years. Conclusions In this observational study, the observed benefits of early BMA administration among patients treated with contemporary anti‐myeloma regimens were similar to historical clinical trials. Frequent omission of BMA highlights a remediable deficiency in the quality of supportive care, and suggests that timely administration may be a useful indicator of quality care in myeloma.
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- 2019
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6. Outcomes of Burkitt lymphoma with central nervous system involvement: evidence from a large multicenter cohort study
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Adam S. Zayac, Andrew M. Evens, Alexey Danilov, Stephen D. Smith, Deepa Jagadeesh, Lori A. Leslie, Catherine Wei, Seo-Hyun Kim, Seema Naik, Suchitra Sundaram, Nishitha Reddy, Umar Farooq, Vaishalee P. Kenkre, Narendranath Epperla, Kristie A. Blum, Nadia Khan, Daulath Singh, Juan P. Alderuccio, Amandeep Godara, Maryam Sarraf Yazdy, Catherine Diefenbach, Emma Rabinovich, Gaurav Varma, Reem Karmali, Yusra Shao, Asaad Trabolsi, Madelyn Burkart, Peter Martin, Sarah Stettner, Ayushi Chauhan, Yun Kyong Choi, Allandria Straker-Edwards, Andreas Klein, Michael C. Churnetski, Kirsten M. Boughan, Stephanie Berg, Bradley M. Haverkos, Victor M. Orellana-Noia, Christopher D'Angelo, David A. Bond, Seth M. Maliske, Ryan Vaca, Gabriella Magarelli, Amy Sperling, Max J. Gordon, Kevin A. David, Malvi Savani, Paolo Caimi, Manali Kamdar, Matthew A Lunning, Neil Palmisiano, Parameswaran Venugopal, Craig A. Portell, Veronika Bachanova, Tycel Phillips, Izidore S. Lossos, and Adam J. Olszewski
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Central nervous system (CNS) involvement in Burkitt lymphoma (BL) poses a major therapeutic challenge, and the relative ability of contemporary regimens to treat CNS involvement remains uncertain. We described prognostic significance of CNS involvement and incidence of CNS recurrence/progression after contemporary immunochemotherapy using real-world clinicopathologic data on adults with BL diagnosed between 2009 and 2018 across 30 US institutions. We examined associations between baseline CNS involvement, patient characteristics, complete response (CR) rates, and survival. We also examined risk factors for CNS recurrence. Nineteen percent (120/641) of patients (age 18-88 years) had CNS involvement. It was independently associated with HIV infection, poor performance status, involvement of ≥2 extranodal sites, or bone marrow involvement. First-line regimen selection was unaffected by CNS involvement (P=0.93). Patients with CNS disease had significantly lower rates of CR (59% versus 77% without; P
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- 2021
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7. Fatal Mucormycosis and Aspergillosis in an Atypical Host: What Do We Know about Mixed Invasive Mold Infections?
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Maria Tsikala-Vafea, Weibiao Cao, Adam J. Olszewski, John E. Donahue, and Dimitrios Farmakiotis
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Infectious and parasitic diseases ,RC109-216 - Abstract
Mixed invasive mold infections (MIMIs) are considered rare. We present a case of fatal aspergillosis and mucormycosis in an elderly host with history of chronic lymphocytic leukemia (CLL) and potential mold exposures. Notably, he had no classic risk factors for IMI other than high-dose corticosteroids, which may be an important risk factor for (M)IMI, based on the current and previous reports. There is an urgent need for studies on the “net state of immunosuppression,” environmental exposure as risk factors for (M)IMIs, and noninvasive fungal diagnostics.
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- 2020
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8. Overexpression of Tpl2 is linked to imatinib resistance and activation of MEK‐ERK and NF‐κB pathways in a model of chronic myeloid leukemia
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Anna Chorzalska, Nagib Ahsan, R. Shyama Prasad Rao, Karim Roder, Xiaoqing Yu, John Morgan, Alexander Tepper, Steven Hines, Peng Zhang, Diana O. Treaba, Ting C. Zhao, Adam J. Olszewski, John L. Reagan, Olin Liang, Philip A. Gruppuso, and Patrycja M. Dubielecka
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Bcr‐Abl1 ,COT1 ,imatinib resistance ,Map3k8 ,stem cells ,Tpl2 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
The introduction of tyrosine kinase inhibitors (TKI) has transformed chronic myeloid leukemia (CML) into a chronic disease with long‐term survival exceeding 85%. However, resistance of CML stem cells to TKI may contribute to the 50% relapse rate observed after TKI discontinuation in molecular remission. We previously described a model of resistance to imatinib mesylate (IM), in which K562 cells cultured in high concentrations of imatinib mesylate showed reduced Bcr‐Abl1 protein and activity levels while maintaining proliferative potential. Using quantitative phosphoproteomic analysis of these IM‐resistant cells, we have now identified significant upregulation of tumor progression locus (Tpl2), also known as cancer Osaka thyroid (COT1) kinase or Map3k8. Overexpression of Tpl2 in IM‐resistant cells was accompanied by elevated activities of Src family kinases (SFKs) and NF‐κB, MEK‐ERK signaling. CD34+ cells isolated from the bone marrow of patients with CML and exposed to IMin vitro showed increased MAP3K8 transcript levels. Dasatinib (SFK inhibitor), U0126 (MEK inhibitor), and PS‐1145 (IκB kinase (IKK) inhibitor) used in combination resulted in elimination of 65% of IM‐resistant cells and reduction in the colony‐forming capacity of CML CD34+ cells in methylcellulose assays by 80%. In addition, CML CD34+ cells cultured with the combination of inhibitors showed reduced MAP3K8 transcript levels. Overall, our data indicate that elevated Tpl2 protein and transcript levels are associated with resistance to IM and that combined inhibition of SFK, MEK, and NF‐κB signaling attenuates the survival of IM‐resistant CML cells and CML CD34+ cells. Therefore, combination of SFK, MEK, and NF‐κB inhibitors may offer a new therapeutic approach to overcome TKI resistance in CML patients.
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- 2018
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9. Therapy and outcomes of primary central nervous system lymphoma in the United States: analysis of the National Cancer Database
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Jaleh Fallah, Lindor Qunaj, and Adam J. Olszewski
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Specialties of internal medicine ,RC581-951 - Abstract
Abstract: Although the role of radiation therapy and chemotherapy in primary central nervous system lymphoma (PCNSL) has evolved considerably over the past decade, the application of treatment modalities in the community has not been evaluated. We analyzed the use of chemotherapy, radiation therapy, and associated overall survival, among 9165 HIV-negative PCSNL cases reported to the US National Cancer Database in 2004-2013. During this time, the proportion of patients receiving chemotherapy significantly increased from 65.6% to 78.8% (P for trend
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- 2016
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10. Increased risk of axial fractures in patients with untreated chronic lymphocytic leukemia: a population-based analysis
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Adam J. Olszewski, Roee Gutman, and Charles B. Eaton
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2016
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11. Paroxysmal Nocturnal Hemoglobinuria Presenting with a Left Intraventricular Thrombus in a Patient with Prior Thymoma and Aplastic Anemia
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Yazan Migdady and Adam J. Olszewski
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2011
12. Small Bowel Adenocarcinoma as the Cause of Gastrointestinal Bleeding in Celiac Disease: A Rare Malignancy in a Common Disease
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Jaleh Fallah, Maxwell Eyram Afari, Alfredo C. Cordova, Adam J. Olszewski, and Taro Minami
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Introduction. Celiac disease is associated with an increased risk of small bowel malignancies, particularly lymphoma. Its association with small bowel carcinoma is less known. Case Description. We report a case of an 89-year-old woman with celiac disease who experienced recurrent episodes of gastrointestinal bleeding and was ultimately found to have adenocarcinoma of the small intestine. Discussion and Evaluation. Diagnosis of small bowel adenocarcinoma is often delayed because of the need for specialized modalities, which are often deferred in the inpatient setting. Although resection is the modality of choice for small bowel tumors, a majority is either locally advanced or metastatic at diagnosis, and even localized cancers have worse prognosis than stage-matched colorectal tumors. The role of adjuvant chemotherapy is uncertain, but it is often offered extrapolating data from other gastrointestinal cancers. Small bowel carcinomas occurring in the context of celiac disease appear to be associated with higher rates of microsatellite instability than sporadic tumors, although other specific genomic abnormalities and mechanisms of carcinogenesis in celiac disease remain unknown. Conclusion. Recurrent episodes of gastrointestinal bleeding in a patient with celiac disease should prompt an early evaluation of the small bowel to assure timely diagnosis of carcinoma at an early curable stage.
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- 2015
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13. Chlorambucil-Induced Acute Interstitial Pneumonitis
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Hammad Shafqat and Adam J. Olszewski
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Chlorambucil is an alkylating agent commonly used in treatment of chronic lymphocytic leukemia (CLL). We report a case of interstitial pneumonitis developing in an 83-year-old man 1.5 months after completing a six-month course of chlorambucil for CLL. The interstitial pneumonitis responded to therapy with prednisone. We performed a systematic review of literature and identified 13 other case reports of chlorambucil-induced pulmonary toxicity, particularly interstitial pneumonitis. No unifying risk factor could be discerned and the mechanism of injury remains unknown. In contrast, major randomized trials of chlorambucil therapy in CLL have not reported interstitial pneumonitis as an adverse effect, which may be due to the rarity of the phenomenon or due to underreporting of events occurring after completion of treatment. Clinicians should consider drug-induced interstitial pneumonitis in the differential diagnosis of a suggestive syndrome developing even after discontinuation of chlorambucil.
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- 2014
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14. CNS Relapse in T-Cell Lymphoma Index: A Risk Score to Predict Central Nervous System Relapse in Patients with T-Cell Lymphomas
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Rahul S. Bhansali, Fredrik Ellin, Miao Cao, Thomas Relander, Wenrui Li, Qi Long, Nivetha Ganesan, Robert Stuver, Steven M. Horwitz, Kitsada Wudhikarn, Steven R Hwang, N. Nora Bennani, Julio C. Chavez, Lubomir Sokol, Hayder Saeed, Frank Duan, Pierluigi Porcu, Priyanka Pullarkat, Neha Mehta-Shah, Jasmine Zain, Miguel Ruiz, Jonathan E Brammer, Rishab Prakash, Swami P. Iyer, Adam J. Olszewski, Ajay Major, Sonali M. Smith, Peter A. Riedell, Caroline Goldin, Bradley M. Haverkos, Bei Hu, Pamela B. Allen, Wael Toama, Murali Janakiram, Taylor Brooks, Deepa Jagadeesh, Nisha Hariharan, Aaron M Goodman, Paola Ghione, Fatima Fayyaz, Joanna M. Rhodes, Elise A. Chong, James N. Gerson, Daniel J. Landsburg, Sunita Dwivedy Nasta, Stephen J. Schuster, Jakub Svoboda, Mats Jerkeman, and Stefan K. Barta
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
15. Choice of anticoagulation in patients with low risk antiphospholipid syndrome
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Brianna R. Bakow, Quan Phung, David Rabinovich, Adam J Olszewski, and John L Reagan
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Hematology ,Cardiology and Cardiovascular Medicine - Published
- 2023
16. High-grade B-cell lymphoma, not otherwise specified: a multi-institutional retrospective study
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Adam Stephen Zayac, Daniel J. Landsburg, Mitchell E. Hughes, Allison M. Bock, Grzegorz S. Nowakowski, Emily C. Ayers, Mark Ryan Girton, Marie Hu, Amy K. Beckman, Shaoying Li, L. Jeffrey Medeiros, Julie E Chang, Adam Stepanovic, Habibe Kurt, Jose Sandoval-Sus, Mohammad Ali Ansari-Lari, Shalin K. Kothari, Anna Kress, Mina L Xu, Pallawi Torka, Suchitra Sundaram, Stephen D Smith, Kikkeri N Naresh, Yasmin H. Karimi, Narendranath Epperla, David A Bond, Umar Farooq, Mahak Saad, Andrew M Evens, Karan Pandya, Seema G. Naik, Manali Kamdar, Bradley M Haverkos, Reem Karmali, Timothy S Oh, Julie M Vose, Heather R Nutsch, Paul G. Rubinstein, Amina Chaudhry, and Adam J Olszewski
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Hematology - Abstract
In this multi-institutional retrospective study, we examined characteristics and outcomes of 160 patients with high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS). This rare lymphoma category is defined by high-grade morphologic features, most commonly Burkitt-like, and lack of MYC rearrangements with BCL2 and/or BCL6 rearrangements (so-called double-hit). Our results show that HGBL-NOS tumors are heterogeneous: 83% had a germinal center B-cell immunophenotype, 37% a dual expressor immunophenotype (MYC and BCL2 expression), 28% (single-hit) MYC rearrangement, 13% BCL2 rearrangement, and 11% BCL6 rearrangement. Most patients presented with stage 4 disease, a high serum lactate dehydrogenase, and other high-risk clinical factors. Most frequent first-line regimens included DA-EPOCH-R (43%), R-CHOP (33%), or other intensive chemotherapy programs (11%). We found no significant differences in the rates of complete response (CR, P=0.32), progression-free (PFS, P=0.82), or overall survival (OS, P=0.60) between these chemotherapy regimens. CR was attained by 69% of patients. PFS at 2 years was 55.2% (95%CI, 46.9-62.7), and OS was 68.1% (95%CI, 59.7-75.0). In a multivariable model, the main prognostic factors for PFS and OS were poor performance status, lactate dehydrogenase >3x upper limit of normal, and a dual expressor immunophenotype. Age >60 years or presence of MYC rearrangement were not prognostic, but patients with TP53 alterations had a dismal PFS (13% at 2 years). Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH-R versus R-CHOP. Improvements in the diagnostic criteria and therapeutic approaches beyond dose-intense chemotherapy are needed to overcome the unfavorable prognosis of patients with HGBL-NOS.
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- 2023
17. <scp>Real‐world</scp> evidence of the safety and survival with <scp>CD19 CAR‐T</scp> cell therapy for relapsed/refractory solid organ <scp>transplant‐related PTLD</scp>
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Marshall McKenna, Narendranath Epperla, Armin Ghobadi, Jieqi Liu, Aleksandr Lazaryan, Uroosa Ibrahim, Caron A. Jacobson, Seema G. Naik, Loretta Nastoupil, Sayan Mullick Chowdhury, Timothy J. Voorhees, Miriam T. Jacobs, Umar Farooq, Keren Osman, Adam J. Olszewski, Sairah Ahmed, and Andrew M. Evens
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Hematology - Published
- 2023
18. Mosunetuzumab Monotherapy Continues to Demonstrate Promising Efficacy and Durable Complete Responses in Elderly/Unfit Patients with Previously Untreated Diffuse Large B-Cell Lymphoma
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Adam J. Olszewski, Abraham Avigdor, Sunil Babu, Itai Levi, Herbert Eradat, Uri Abadi, Houston Holmes, Matthew McKinney, Dariusz Woszczyk, Krzysztof Giannopoulos, Wojciech Jurczak, Diana Dunshee, Annie Yang, Mingzhu Zhou, Naseer Qayum, Gila Sellam, and Netanel A. Horowitz
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
19. Early Relapse within 24 Months after Frontline Systemic Therapy (POD24) Is Associated with Worse Survival in Patients with Marginal Zone Lymphoma: A US Multisite Study
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Narendranath Epperla, Rui Li, Pallawi Torka, Lauren Shea, Reem Karmali, Andrea Anampa-Guzman, Timothy Seijung Oh, Kathryn Lindsey, Irl Brian Greenwell, Sayan Mullick Chowdhury, Kaitlin Annunzio, Beth Christian, Geoffrey Shouse, Alex F. Herrera, Nancy L. Bartlett, Natalie S. Grover, and Adam J. Olszewski
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
20. High-Grade B-Cell Lymphoma, Not Otherwise Specified (HGBL, NOS): Central Nervous System (CNS) Involvement, Prophylaxis, and Recurrence Risk in a Multi-Institutional Series
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Narendranath Epperla, Adam Zayac, Daniel J. Landsburg, Mitchell Hughes, Allison M. Bock, Grzegorz S. Nowakowski, Emily C. Ayers, Mark Girton, Marie Hu, Amy Beckman, Shaoying Li, L. Jeffrey Medeiros, Julie E. Chang, Adam Stepanovic, Habibe Kurt, Jose Sandoval-Sus, M. Ali Ansari-Lari, Shalin K. Kothari, Anna Kress, Mina L Xu, Pallawi Torka, Suchitra Sundaram, Stephen D Smith, Kikkeri N Naresh, Yasmin Karimi, David A. Bond, Umar Farooq, Mahak Saad, Andrew Matthew Evens, Karan Pandya, Seema G Naik, Manali Kamdar, Bradley M. Haverkos, Reem Karmali, Timothy S Oh, Julie M. Vose, Heather Nutsch, Paul Rubinstein, Amina Chaudhry, and Adam J. Olszewski
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
21. Mosunetuzumab with Polatuzumab Vedotin Is Effective and Has a Manageable Safety Profile in Patients Aged <65 and ≥65 Years with Relapsed/Refractory Diffuse Large B-Cell Lymphoma (R/R DLBCL) and ≥1 Prior Therapy: Subgroup Analysis of a Phase Ib/II Study
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Adam J. Olszewski, L. Elizabeth Budde, Julio Chavez, Nilanjan Ghosh, Manali Kamdar, Izidore S. Lossos, Catherine Diefenbach, Waleed Sabry, Kathleen Dorritie, Ling-Yuh Huw, Song Pham, Ting Jia, Hao Wu, Iris To, Michael C. Wei, and Sarit Assouline
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
22. Impact of Monoclonal Protein at Diagnosis on Outcomes in Patients with Marginal Zone Lymphoma: A Multicenter Cohort Study
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Narendranath Epperla, Qiuhong Zhao, Lauren Shea, Reem Karmali, Pallawi Torka, Timothy Seijung Oh, Andrea Anampa-Guzman, Ximena Jordan Bruno, Elvira Umyarova, Kathryn Lindsey, Irl Brian Greenwell, Sayan Mullick Chowdhury, Yazeed Sawalha, Beth Christian, Natalie S. Grover, Nancy L. Bartlett, and Adam J. Olszewski
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
23. Seroconversion and outcomes after initial and booster <scp>COVID</scp> ‐19 vaccination in adults with hematologic malignancies
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Thomas A. Ollila, Rebecca H. Masel, John L. Reagan, Shaolei Lu, Ralph D. Rogers, Kimberly J. Paiva, Rashida Taher, Ella Burguera‐Couce, Adam S. Zayac, Inna Yakirevich, Rabin Niroula, Peter Barth, and Adam J. Olszewski
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Adult ,Cancer Research ,COVID-19 Vaccines ,Oncology ,Seroconversion ,Hematologic Neoplasms ,Vaccination ,Antibodies, Monoclonal ,COVID-19 ,Humans ,Hepatitis B Vaccines ,Antibodies, Viral ,Retrospective Studies - Abstract
Patients with hematologic malignancies have impaired humoral immunity secondary to their malignancy and its treatment, placing them at risk of severe coronavirus disease-19 (COVID-19) infection and reduced response to vaccination.The authors retrospectively analyzed serologic responses to initial and booster COVID-19 vaccination in 378 patients with hematologic malignancy and subsequently tracked COVID-19-related outcomes.Seroconversion occurred in 181 patients (48%) after initial vaccination; patients who had active malignancy or those who were recently treated with a B-cell-depleting monoclonal antibody had the lowest rates of seroconversion. For initial nonresponders to vaccination, seroconversion after a booster dose occurred in 48 of 85 patients (56%). The seroconversion rate after the booster was similar for patients on (53%) and off (58%) active therapy (p = .82). Thirty-three patients (8.8%) developed a COVID-19 infection, and there were three COVID-19-related deaths (0.8%). Although no significant association was observed between postvaccination seroconversion and the incidence of COVID-19 infection, no patient with seroconversion died from COVID-19, and no patient who received tixagevimab/cilgavimab (N = 25) was diagnosed with a COVID-19 infection.Booster vaccinations can promote seroconversion in a significant proportion of patients who are seronegative after the initial vaccination course regardless of the specific vaccine or on/off treatment status at the time of revaccination. Although postvaccination seroconversion may not be associated with a decrease in any (including asymptomatic) COVID-19 infection, the authors' experience suggested that effective vaccination (including a booster), supplemented by passive immunization using tixagevimab/cilgavimab in case of lack of seroconversion, effectively eliminated the risk of COVID-19 death in the otherwise high-risk population.Patients with hematologic malignancy, especially lymphoma, have an impaired response to coronavirus disease 2019 (COVID-19) vaccination. In this single-institution review, less than one half of the patients studied made detectable antibodies. For those who did not make detectable antibodies after initial vaccination, over one half (65%) were able to produce antibodies after booster vaccination. By the end of February 2022, 33 of the original 378 patients had a documented COVID-19 infection. The only deaths from COVID-19 were in those who had undetectable antibodies, and no patient who received prophylactic antibody therapy developed a COVID-19 infection.
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- 2022
24. Pre-treatment neutrophil to lymphocyte ratio as a biomarker of frailty and predictor of survival among older adults with multiple myeloma
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Smith Giri, Sumit Dahal, Susan Bal, Kelly N. Godby, Joshua Richman, Adam J. Olszewski, Grant R. Williams, Cynthia Brown, Thomas W. Buford, Luciano J. Costa, and Smita Bhatia
- Subjects
Frailty ,Oncology ,Neutrophils ,Humans ,Lymphocytes ,Geriatrics and Gerontology ,Multiple Myeloma ,Prognosis ,Biomarkers ,Aged ,Retrospective Studies - Abstract
Neutrophil to Lymphocyte Ratio (NLR) combines a marker of inflammation and reduced cell turnover to reflect age related alterations in the immune system. Whether NLR can serve as a biomarker of frailty and predict survival among older adults with Multiple Myeloma (MM) is unknown.We used an electronic health record-derived database to identify older adults (age ≥ 60y) with incident MM diagnosed between 1/2011 and 2/2020, with known pre-treatment absolute neutrophil and lymphocyte count up to 90 days before the start of therapy. The calculated NLR values were stratified into quartiles (Q1-Q4). We constructed a previously validated, simplified frailty index combining age, comorbidity and ECOG performance status. We measured the association between NLR quartiles and this frailty index using a logistic regression, adjusted for age, sex and race/ethnicity. We used Kaplan Meier methods and multivariable Cox regression to assess the impact of NLR on overall survival adjusting for potential confounders.We identified 1729 older adults with newly diagnosed MM, at a median age of 73y (IQR: 67-78y). The median NLR was 2.13 (IQR: 1.44 to 3.31). Of the 1135 evaluable patients, 55% met criteria for frailty. Multivariable analysis revealed a 2.1-fold higher odds of frailty (95%CI = 1.42-3.10, p 0.001) for patients in the NLR Q4 group vs. NLR Q1 group. In a multivariable analysis, adjusting for age, sex, race/ethnicity, M-protein type, stage, high risk cytogenetics, baseline creatinine, LDH and type of first line therapy, patients in NLR Q4 group had a 1.51 times increased hazards of death (95%CI = 1.15-1.98, p 0.002) when compared to those in NLR Q1 group.NLR, a readily available laboratory biomarker, is associated with frailty measured using a simplified frailty index as well as inferior overall survival among older adults with MM. Future studies should explore its value as a screening tool to identify frail older adults with MM.
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- 2022
25. Data from Patients Recently Treated for B-lymphoid Malignancies Show Increased Risk of Severe COVID-19
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Michael A. Thompson, Jeremy L. Warner, Leyre Zubiri, Trisha M. Wise-Draper, Pallawi Torka, Christopher Su, Aditi Shastri, Sumit A. Shah, Andrew Schmidt, Rachel Rosovski, Pedram Razavi, Matthew M. Puc, Andrew J. Portuguese, Hyma V. Polimera, Adam J. Olszewski, Taylor K. Nonato, Amanda Nizam, Gayathri Nagaraj, Rana R. McKay, Gary H. Lyman, Xuanyi Li, Eric Lau, Tahir Latif, Chris Labaki, Daniel H. Kwon, Nicole M. Kuderer, Vadim S. Koshkin, Elizabeth J. Klein, Anup Kasi, Monika Joshi, Nathalie A. Johnson, Clara Hwang, Daniel Hausrath, Shilpa Gupta, Christopher R. Friese, Devendra KC, Jacob C. Cogan, Cecilia A. Castellano, Mehmet Asim Bilen, Stephanie Berg, Babar Bashir, Ziad Bakouny, Joy Awosika, Sarit E. Assouline, Melissa Accordino, Alicia Beeghly-Fadiel, Matthias Weiss, Catherine Stratton, Keith E. Stockerl-Goldstein, R. Alejandro Sica, Dimpy P. Shah, Daniel P. Mundt, Sanjay Mishra, Ruben A. Mesa, Shailesh Advani, Yu Shyr, Chih-Yuan Hsu, Ryan C. Lynch, Divaya Bhutani, and Samuel M. Rubinstein
- Abstract
Patients with B-lymphoid malignancies have been consistently identified as a population at high risk of severe COVID-19. Whether this is exclusively due to cancer-related deficits in humoral and cellular immunity, or whether risk of severe COVID-19 is increased by anticancer therapy, is uncertain. Using data derived from the COVID-19 and Cancer Consortium (CCC19), we show that patients treated for B-lymphoid malignancies have an increased risk of severe COVID-19 compared with control populations of patients with non–B-lymphoid malignancies. Among patients with B-lymphoid malignancies, those who received anticancer therapy within 12 months of COVID-19 diagnosis experienced increased COVID-19 severity compared with patients with non–recently treated B-lymphoid malignancies, after adjustment for cancer status and several other prognostic factors. Our findings suggest that patients recently treated for a B-lymphoid malignancy are at uniquely high risk for severe COVID-19.Significance:Our study suggests that recent therapy for a B-lymphoid malignancy is an independent risk factor for COVID-19 severity. These findings provide rationale to develop mitigation strategies targeted at the uniquely high-risk population of patients with recently treated B-lymphoid malignancies.This article is highlighted in the In This Issue feature, p. 171
- Published
- 2023
26. Supplementary Figure from Patients Recently Treated for B-lymphoid Malignancies Show Increased Risk of Severe COVID-19
- Author
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Michael A. Thompson, Jeremy L. Warner, Leyre Zubiri, Trisha M. Wise-Draper, Pallawi Torka, Christopher Su, Aditi Shastri, Sumit A. Shah, Andrew Schmidt, Rachel Rosovski, Pedram Razavi, Matthew M. Puc, Andrew J. Portuguese, Hyma V. Polimera, Adam J. Olszewski, Taylor K. Nonato, Amanda Nizam, Gayathri Nagaraj, Rana R. McKay, Gary H. Lyman, Xuanyi Li, Eric Lau, Tahir Latif, Chris Labaki, Daniel H. Kwon, Nicole M. Kuderer, Vadim S. Koshkin, Elizabeth J. Klein, Anup Kasi, Monika Joshi, Nathalie A. Johnson, Clara Hwang, Daniel Hausrath, Shilpa Gupta, Christopher R. Friese, Devendra KC, Jacob C. Cogan, Cecilia A. Castellano, Mehmet Asim Bilen, Stephanie Berg, Babar Bashir, Ziad Bakouny, Joy Awosika, Sarit E. Assouline, Melissa Accordino, Alicia Beeghly-Fadiel, Matthias Weiss, Catherine Stratton, Keith E. Stockerl-Goldstein, R. Alejandro Sica, Dimpy P. Shah, Daniel P. Mundt, Sanjay Mishra, Ruben A. Mesa, Shailesh Advani, Yu Shyr, Chih-Yuan Hsu, Ryan C. Lynch, Divaya Bhutani, and Samuel M. Rubinstein
- Abstract
Supplementary Figure from Patients Recently Treated for B-lymphoid Malignancies Show Increased Risk of Severe COVID-19
- Published
- 2023
27. Data from Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study
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Jeremy L. Warner, Gary H. Lyman, Yu Shyr, Huili Zhu, Albert C. Yeh, Zhuoer Xie, Julie T. Wu, Sumit A. Shah, Gary K. Schwartz, Andrew Schmidt, Lidia Schapira, Sanjay G. Revankar, Matthew M. Puc, Nathan A. Pennell, Adam J. Olszewski, Sanjay Mishra, Christopher A. Lemmon, Ali Raza Khaki, Jessica E. Hawley, Balazs Halmos, Thorvardur R. Halfdanarson, Shilpa Gupta, Sanjay Goel, Matthew D. Galsky, Christopher R. Friese, Leslie A. Fecher, Dimitrios Farmakiotis, Pamela C. Egan, Deborah B. Doroshow, Ziad Bakouny, Jonathan Arcobello, Michael A. Thompson, Brian I. Rini, Corrie A. Painter, Petros Grivas, Gilberto de Lima Lopes, Toni K. Choueiri, Brendan J. Lee, Samuel M. Rubinstein, Chih-Yuan Hsu, Nicole M. Kuderer, Dimpy P. Shah, Orestis A. Panagiotou, Solange Peters, and Donna R. Rivera
- Abstract
Among 2,186 U.S. adults with invasive cancer and laboratory-confirmed SARS-CoV-2 infection, we examined the association of COVID-19 treatments with 30-day all-cause mortality and factors associated with treatment. Logistic regression with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) was performed. Hydroxychloroquine with any other drug was associated with increased mortality versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated controls; this association was not present with hydroxychloroquine alone. Remdesivir had numerically reduced mortality versus untreated controls that did not reach statistical significance. Baseline COVID-19 severity was strongly associated with receipt of any treatment. Black patients were approximately half as likely to receive remdesivir as white patients. Although observational studies can be limited by potential unmeasured confounding, our findings add to the emerging understanding of patterns of care for patients with cancer and COVID-19 and support evaluation of emerging treatments through inclusive prospective controlled trials.Significance:Evaluating the potential role of COVID-19 treatments in patients with cancer in a large observational study, there was no statistically significant 30-day all-cause mortality benefit with hydroxychloroquine or high-dose corticosteroids alone or in combination; remdesivir showed potential benefit. Treatment receipt reflects clinical decision-making and suggests disparities in medication access.This article is highlighted in the In This Issue feature, p. 1426
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- 2023
28. Supplementary Data from Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study
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Jeremy L. Warner, Gary H. Lyman, Yu Shyr, Huili Zhu, Albert C. Yeh, Zhuoer Xie, Julie T. Wu, Sumit A. Shah, Gary K. Schwartz, Andrew Schmidt, Lidia Schapira, Sanjay G. Revankar, Matthew M. Puc, Nathan A. Pennell, Adam J. Olszewski, Sanjay Mishra, Christopher A. Lemmon, Ali Raza Khaki, Jessica E. Hawley, Balazs Halmos, Thorvardur R. Halfdanarson, Shilpa Gupta, Sanjay Goel, Matthew D. Galsky, Christopher R. Friese, Leslie A. Fecher, Dimitrios Farmakiotis, Pamela C. Egan, Deborah B. Doroshow, Ziad Bakouny, Jonathan Arcobello, Michael A. Thompson, Brian I. Rini, Corrie A. Painter, Petros Grivas, Gilberto de Lima Lopes, Toni K. Choueiri, Brendan J. Lee, Samuel M. Rubinstein, Chih-Yuan Hsu, Nicole M. Kuderer, Dimpy P. Shah, Orestis A. Panagiotou, Solange Peters, and Donna R. Rivera
- Abstract
Supplemental tables, figures, and list of participants
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- 2023
29. Functional status and therapy for older adults with diffuse large B‐cell lymphoma in nursing homes: A population‐based study
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Mengyang Di, Tamra Keeney, Emmanuelle Belanger, Scott F. Huntington, Adam J. Olszewski, and Orestis A. Panagiotou
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Geriatrics and Gerontology - Published
- 2023
30. Global Risk Indicator and Therapy for Older Patients With Diffuse Large B-Cell Lymphoma: A Population-Based Study
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Mengyang Di, Orestis A. Panagiotou, Tamra Keeney, Adam J. Olszewski, and Emmanuelle Belanger
- Subjects
Pediatrics ,medicine.medical_specialty ,Medicare ,ORIGINAL CONTRIBUTIONS ,Care recipient ,Older patients ,Risk Factors ,medicine ,Humans ,Selection (genetic algorithm) ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Oncology (nursing) ,business.industry ,Health Policy ,Cognition ,medicine.disease ,United States ,Population based study ,Intensive Care Units ,Oncology ,Lymphoma, Large B-Cell, Diffuse ,business ,Diffuse large B-cell lymphoma ,Global risk - Abstract
PURPOSE: To examine the impact of global risk, a measure comprising age, comorbidities, function, and cognitive statuses, on treatment selection and outcomes among older home care recipients with diffuse large B-cell lymphoma. METHODS: From SEER-Medicare, we selected home care recipients diagnosed with diffuse large B-cell lymphoma in 2011-2015, who had pretreatment Outcome and Assessment Information Set (OASIS) evaluations. We created a global risk indicator categorizing patients as low-, moderate-, or high-risk on the basis of OASIS assessments. We examined the association of global risk with receipt of therapy and among chemotherapy recipients, with mortality, emergency department visits, hospitalization, and intensive care unit admission within 30 days from first treatment in logistic models, reporting adjusted odds ratios (OR) with 95% CI. We compared overall survival across risk groups estimating adjusted hazard ratios. RESULTS: Of the 1,232 patients (median age, 80 years), 65% received chemotherapy. High-risk patients ( v moderate-risk) were less likely to receive any chemotherapy (OR, 0.50; 95% CI, 0.39 to 0.64) and curative regimens (OR, 0.59; 95% CI, 0.40 to 0.86) if treated, although even in the moderate-risk group, only 61% received curative regimens. High-risk patients were more likely to experience acute mortality (OR, 2.24; 95% CI, 1.43 to 3.52), emergency department visits (OR, 1.35; 95% CI, 1.00 to 1.83), hospitalization (OR, 1.60; 95% CI, 1.19 to 2.17), or intensive care unit admission (OR, 1.52; 95% CI, 1.04 to 2.22) and had inferior overall survival (hazard ratio, 1.41; 95% CI, 1.11 to 1.78). CONCLUSION: Global risk on the basis of OASIS is easily available, suggesting a potential way to improve patient selection for curative treatment and institution of preventive measures.
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- 2022
31. Detection of clonotypic DNA in the cerebrospinal fluid as a marker of central nervous system invasion in lymphoma
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Andrew R. Hsu, Pamela C Egan, Diana O. Treaba, Max Petersen, James N. Butera, Rabin Niroula, Adam J. Olszewski, Anna Chorzalska, Patrycja M. Dubielecka, John L. Reagan, Thomas A Ollila, Adam Zayac, John Vatkevich, Jordan Robison, Ilyas Sahin, Chelsea D. Mullins, Habibe Kurt, and Allison P. Jacob
- Subjects
Central Nervous System ,Pathology ,medicine.medical_specialty ,Lymphoma, B-Cell ,Clinical Trials and Observations ,Central nervous system ,Aggressive lymphoma ,Flow cytometry ,law.invention ,chemistry.chemical_compound ,Cerebrospinal fluid ,law ,Cytology ,hemic and lymphatic diseases ,Medicine ,Humans ,Polymerase chain reaction ,medicine.diagnostic_test ,business.industry ,Lymphoma, Non-Hodgkin ,Hematology ,DNA ,medicine.disease ,Lymphoma ,medicine.anatomical_structure ,chemistry ,business ,Biomarkers - Abstract
Key Points The NGS-MRD assay detected clonotypic DNA in 100% of CSF samples from patients who had lymphoma with parenchymal CNS involvement.Clonotypic DNA in CSF was present in 36% of newly diagnosed aggressive lymphomas and was associated with a 29% risk of CNS recurrence., Visual Abstract, The diagnosis of parenchymal central nervous system (CNS) invasion and prediction of risk for future CNS recurrence are major challenges in the management of aggressive lymphomas, and accurate biomarkers are needed to supplement clinical risk predictors. For this purpose, we studied the results of a next-generation sequencing (NGS)–based assay that detects tumor-derived DNA for clonotypic immunoglobulin gene rearrangements in the cerebrospinal fluid (CSF) of patients with lymphomas. Used as a diagnostic tool, the NGS-minimal residual disease (NGS-MRD) assay detected clonotypic DNA in 100% of CSF samples from 13 patients with known CNS involvement. They included 7 patients with parenchymal brain disease only, whose CSF tested negative by standard cytology and flow cytometry, and 6 historical DNA aliquots collected from patients at a median of 39 months before accession, which had failed to show clonal rearrangements using standard polymerase chain reaction. For risk prognostication, we prospectively collected CSF from 22 patients with newly diagnosed B-cell lymphomas at high clinical risk of CNS recurrence, of whom 8 (36%) had detectable clonotypic DNA in the CSF. Despite intrathecal prophylaxis, a positive assay of CSF was associated with a 29% cumulative risk of CNS recurrence within 12 months of diagnosis, in contrast with a 0% risk among patients with negative CSF (P = .045). These observations suggest that detection of clonotypic DNA can aid in the diagnosis of suspected parenchymal brain recurrence in aggressive lymphoma. Furthermore, the NGS-MRD assay may enhance clinical risk assessment for CNS recurrence among patients with newly diagnosed lymphomas and help select those who may benefit most from novel approaches to CNS-directed prophylaxis.
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- 2021
32. BrUOG 345: Fractionated Gemtuzumab Ozogamicin Followed By Nonengraftment Donor Leukocyte Infusions for Relapsed/Refractory Acute Myeloid Leukemia
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Dr. John L Reagan, Rabin Niroula, Jessica McMahon, Elaine Papa, Pamela Egan, Inna Yakirevich, Ari Pelcovits, Adam J Olszewski, Jeannine Margolis, Ashlee Sturtevant, Peter Quesenberry, and Loren Fast
- Subjects
Transplantation ,Molecular Medicine ,Immunology and Allergy ,Cell Biology ,Hematology - Published
- 2023
33. Transcriptomics of acute myeloid leukaemia core bone marrow biopsies reveals distinct therapy response-specific osteo-mesenchymal profiles
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Diana O. Treaba, Dennis M. Bonal, Anna Chorzalska, Mireia Castillo‐Martin, Alissa Oakes, Makayla Pardo, Max Petersen, Christoph Schorl, Kelsey Hopkins, Dean Melcher, Ting C. Zhao, Olin Liang, Eui‐Young So, John Reagan, Adam J. Olszewski, James Butera, Douglas C. Anthony, Peter Rintels, Peter Quesenberry, and Patrycja M. Dubielecka
- Subjects
Hematology - Abstract
While the bone marrow (BM) microenvironment is significantly remodelled in acute myeloid leukaemia (AML), molecular insight into AML-specific alterations in the microenvironment has been historically limited by the analysis of liquid marrow aspirates rather than core biopsies that contain solid-phase BM stroma. We assessed the effect of anthracycline- and cytarabine-based induction chemotherapy on both haematopoietic and non-haematopoietic cells directly in core BM biopsies using RNA-seq and histological analysis. We compared matched human core BM biopsies at diagnosis and 2 weeks after cytarabine- and anthracycline-based induction therapy in responders (5% blasts present after treatment) and non-responders (≥5% blasts present after treatment). Our data indicated enrichment in vimentin (VIM), platelet-derived growth factor receptor beta (PDGFRB) and Snail family transcriptional repressor 2 (SNAI2) transcripts in responders, consistent with the reactivation of the mesenchymal population in the BM stroma. Enrichment of osteoblast maturation-related transcripts of biglycan (BGN), osteopontin (SPP1) and osteonectin (SPARC) was observed in non-responders. To the best of our knowledge, this is the first report demonstrating distinct osteogenic and mesenchymal transcriptome profiles specific to AML response to induction chemotherapy assessed directly in core BM biopsies. Detailing treatment response-specific alterations in the BM stroma may inform optimised therapeutic strategies for AML.
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- 2022
34. Neoadjuvant weekly paclitaxel and carboplatin with trastuzumab and pertuzumab in HER2-positive breast cancer: a Brown University Oncology Research Group (BrUOG) study
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Christine M Emmick, Ashley Stuckey, Marlene Cutitar, Jennifer Gass, Sabrina M Witherby, Robert D. Legare, Mary Anne Fenton, William M. Sikov, Mary L Lopresti, Rochelle Strenger, Jessica J Bian, Theresa A. Graves, David A Edmondson, Sonali V Pandya, Bachir J. Sakr, Donald S Dizon, and Adam J. Olszewski
- Subjects
0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Loading dose ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Trastuzumab ,Internal medicine ,medicine ,Neoadjuvant therapy ,Chemotherapy ,business.industry ,medicine.disease ,Carboplatin ,Regimen ,030104 developmental biology ,chemistry ,030220 oncology & carcinogenesis ,Pertuzumab ,business ,Febrile neutropenia ,medicine.drug - Abstract
In HER2-positive breast cancer (HER2+ BC), neoadjuvant chemotherapy (NACT) with dual HER2-targeted therapy achieves high pathologic complete response (pCR) rates. Anthracycline-free NACT regimens avoid toxicities associated with anthracyclines, but every 3-week TCHP also has substantial side effects. We hypothesized that a weekly regimen might have equivalent efficacy with less toxicity; we also investigated whether poorly responding patients would benefit from switching to AC. Patients with clinical stage II–III HER2+ BC received weekly paclitaxel 80 mg/m2 and carboplatin AUC2 with every 3-week trastuzumab and pertuzumab (wPCbTP), with the option of splitting the pertuzumab loading dose. After 12 weeks, responding patients continued wPCbTP for another 6 weeks, while non-responders switched to AC. Dose modifications and post-op therapy were at investigator discretion. In 30 evaluable patients, the pCR rate was 77% (95% CI 58–90%); 12/14 (86%) in ER-negative and 11/16 (69%) in ER-positive. Only two patients transitioned to AC for non-response, of which one achieved pCR. There were no episodes of febrile neutropenia or grade ≥ 3 peripheral neuropathy, though several patients who continued wPCbTP stopped before week 18. Split-dose pertuzumab was associated with less grade ≥ 2 diarrhea (40%) than the standard loading dose (60%). pCR rates with our regimen were as high as reported with TCHP with fewer grade ≥ 3 toxicities, though diarrhea remains a concern. Too few patients had a suboptimal response to adequately test switching to AC. The wPCbTP regimen should be considered an alternative to TCHP as neoadjuvant therapy for HER2+ BC. ClinicalTrials.gov identifier: NCT02789657.
- Published
- 2021
35. WhiMSICAL: A global Waldenström's Macroglobulinemia patient-derived data registry capturing treatment and quality of life outcomes
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Adam J. Olszewski, Damien Kee, Clare L. Scott, Shirley D'Sa, Marie José Kersten, Ibrahim Tohidi-Esfahani, Carl Harrington, Ruth Spearing, Judith Trotman, Peter Liburdi deNardis, Maria Lia Palomba, Stephen Opat, Marita Black, Javier Haurat, Andrew C. Warden, Elena Malunis, and Clinical Haematology
- Subjects
medicine.medical_specialty ,MEDLINE ,Antineoplastic Agents ,Global Health ,Quality of life (healthcare) ,medicine ,Global health ,Humans ,Patient Reported Outcome Measures ,Registries ,Practice Patterns, Physicians' ,Intensive care medicine ,Clinical Trials as Topic ,Practice patterns ,business.industry ,Australia ,Cancer ,Waldenstrom macroglobulinemia ,Macroglobulinemia ,Hematology ,medicine.disease ,Quality of Life ,Feasibility Studies ,Waldenstrom Macroglobulinemia ,business ,Derived Data - Published
- 2021
36. SUNMO: A Phase III Trial Evaluating the Efficacy and Safety of Mosunetuzumab in Combination with Polatuzumab Vedotin Versus Rituximab in Combination with Gemcitabine Plus Oxaliplatin in Patients with Relapsed or Refractory Aggressive B-Cell Non-Hodgkin Lymphoma
- Author
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Jason Westin, Adam J. Olszewski, Laura Maria Fogliatto, Won-Seog Kim, Ho-Jin Shin, Hao Wu, Shen Yin, Song Pham, Elicia Penuel, Jing Jing, Michael C. Wei, and Elizabeth L. Budde
- Subjects
Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
37. Effective Cell Dose and Functional Attributes of Azercabtagene Zapreleucel (azer-cel; PBCAR0191) Associate with Allogeneic CAR T-Cell Safety and Efficacy in Patients with Relapsed/Refractory B-Cell Lymphoma
- Author
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Caron A. Jacobson, Tilanthi Jayawardena, Lou Yu, Jason Hallman, Robert Schmittling, Erin Cuneo, Ian Belle, Gavin Sampey, Danica Cabral, Ashleigh Derrick, Josie Tueller, Koen Van Besien, Scott R. Solomon, Adam J. Olszewski, Joseph E. Maakaron, Ran Reshef, Anthony S. Stein, Abhinav Deol, Nitin Jain, Alan F. List, and Bijal D. Shah
- Subjects
Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
38. Mosunetuzumab with Lenalidomide Augmentation As First-Line Therapy for Follicular (FL) and Marginal Zone Lymphoma (MZL)
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Adam J. Olszewski, Scott F. Huntington, Rajat Bannerji, Thomas A. Ollila, Jessica McMahon, and Patrycja M Dubielecka
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
39. Outcomes of Primary Central Nervous System Lymphoma (PCNSL) Treated with Immunochemotherapy or Chemotherapy Alone: Analysis of the National Cancer Data Base 2013-2018
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Thomas A. Ollila, Rashida Taher, Stephen Grado, and Adam J. Olszewski
- Subjects
Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
40. Burkitt Lymphoma International Prognostic Index
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Narendranath Epperla, Nicolas Martinez-Calle, Veronika Bachanova, David Peace, Seo-Hyun Kim, Maryam Sarraf Yazdy, Andreas K. Klein, Andrew M. Evens, Neil Palmisiano, Scott E. Smith, Catherine Zhu, Manali Kamdar, Adam Zayac, Izidore S. Lossos, Catherine Diefenbach, Nadia Khan, Elizabeth H Phillips, Matthew A. Lunning, Alessia Dalla Pria, Knut B. Smeland, Chan Yoon Cheah, Adam J. Olszewski, Peter Martin, Anna Santarsieri, Kirsten M Boughan, Umar Farooq, Alexey V. Danilov, Graham P. Collins, Tycel Phillips, Reem Karmali, Alina S. Gerrie, Silvia Montoto, Stephen D. Smith, Shireen Kassam, Kevin A. David, Mark Bower, Deepa Jagadeesh, Tarec Christoffer El-Galaly, Kate Cwynarski, Suchitra Sundaram, Xiao Yin Zhang, Vaishalee P. Kenkre, Fredrik Ellin, Tatyana Feldman, Lasse Hjort Jakobsen, Craig A. Portell, Seema Naik, Nishitha Reddy, and Kristie A. Blum
- Subjects
Adult ,Male ,Oncology ,Canada ,Cancer Research ,medicine.medical_specialty ,Kaplan-Meier Estimate ,Cohort Studies ,International Prognostic Index ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Outcome Assessment, Health Care ,medicine ,Humans ,Hematology ,business.industry ,Australia ,Clinical course ,ORIGINAL REPORTS ,Middle Aged ,Prognosis ,medicine.disease ,Burkitt Lymphoma ,United States ,Lymphoma ,Europe ,Multivariate Analysis ,Prognostic model ,Female ,Rituximab ,business - Abstract
PURPOSE Burkitt lymphoma (BL) has unique biology and clinical course but lacks a standardized prognostic model. We developed and validated a novel prognostic index specific for BL to aid risk stratification, interpretation of clinical trials, and targeted development of novel treatment approaches. METHODS We derived the BL International Prognostic Index (BL-IPI) from a real-world data set of adult patients with BL treated with immunochemotherapy in the United States between 2009 and 2018, identifying candidate variables that showed the strongest prognostic association with progression-free survival (PFS). The index was validated in an external data set of patients treated in Europe, Canada, and Australia between 2004 and 2019. RESULTS In the derivation cohort of 633 patients with BL, age ≥ 40 years, performance status ≥ 2, serum lactate dehydrogenase > 3× upper limit of normal, and CNS involvement were selected as equally weighted factors with an independent prognostic value. The resulting BL-IPI identified groups with low (zero risk factors, 18% of patients), intermediate (one factor, 36% of patients), and high risk (≥ 2 factors, 46% of patients) with 3-year PFS estimates of 92%, 72%, and 53%, respectively, and 3-year overall survival estimates of 96%, 76%, and 59%, respectively. The index discriminated outcomes regardless of HIV status, stage, or first-line chemotherapy regimen. Patient characteristics, relative size of the BL-IPI groupings, and outcome discrimination were consistent in the validation cohort of 457 patients, with 3-year PFS estimates of 96%, 82%, and 63% for low-, intermediate-, and high-risk BL-IPI, respectively. CONCLUSION The BL-IPI provides robust discrimination of survival in adult BL, suitable for use as prognostication and stratification in trials. The high-risk group has suboptimal outcomes with standard therapy and should be considered for innovative treatment approaches.
- Published
- 2021
41. Genomic subtypes may predict the risk of central nervous system recurrence in diffuse large B-cell lymphoma
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Nimesh R. Patel, Adam J. Olszewski, Diana O. Treaba, Jozal Waroich, Ashlee Sturtevant, Patrycja M. Dubielecka, Thomas A Ollila, Habibe Kurt, and John Vatkevich
- Subjects
Male ,0301 basic medicine ,Pathology ,medicine.medical_specialty ,Immunology ,Central nervous system ,Biochemistry ,Genome ,Central Nervous System Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Humans ,Medicine ,Aged ,Aged, 80 and over ,Gene Rearrangement ,business.industry ,Cell Biology ,Hematology ,Middle Aged ,medicine.disease ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Mutation ,Female ,Lymphoma, Large B-Cell, Diffuse ,Neoplasm Recurrence, Local ,business ,Diffuse large B-cell lymphoma - Abstract
Ollila et al address a challenging problem: can the risk for central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma be predicted better on a molecular basis? They report that most tumors with CNS recurrence have recognizable molecular features that fall into two categories: those that resemble primary CNS lymphoma and those that resemble high-grade lymphoma. These data suggest that it is time to revisit identification of patients who may benefit from CNS prophylaxis, while highlighting how challenging that is.
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- 2021
42. Outcomes of Burkitt lymphoma with central nervous system involvement: evidence from a large multicenter cohort study
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Craig A. Portell, Seo-Hyun Kim, Catherine Wei, Neil Palmisiano, Catherine Diefenbach, Manali Kamdar, Madelyn Burkart, Nadia Khan, Seth M. Maliske, Izidore S. Lossos, Andreas K. Klein, Paolo Caimi, Narendranath Epperla, Amandeep Godara, Alexey V. Danilov, Victor M. Orellana-Noia, Max J. Gordon, Adam Zayac, Maryam Sarraf Yazdy, Allandria Straker-Edwards, Michael C. Churnetski, Ayushi Chauhan, Umar Farooq, Deepa Jagadeesh, Daulath Singh, Matthew A. Lunning, Suchitra Sundaram, Sarah Stettner, Kirsten M Boughan, Lori A. Leslie, Yusra F. Shao, Peter Martin, Amy Sperling, Stephen D. Smith, Reem Karmali, Bradley M. Haverkos, Parameswaran Venugopal, Veronika Bachanova, Tycel Phillips, Yun Kyong Choi, Malvi Savani, Seema Naik, Gaurav Varma, Vaishalee P. Kenkre, Gabriella Magarelli, Ryan Vaca, Asaad Trabolsi, Andrew M. Evens, Juan Pablo Alderuccio, Emma Rabinovich, Christopher D'Angelo, Nishitha Reddy, Adam J. Olszewski, Kristie A. Blum, Stephanie Berg, David A. Bond, and Kevin A. David
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,Hematology ,medicine.disease ,Lower risk ,Lymphoma ,03 medical and health sciences ,Regimen ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Cumulative incidence ,Young adult ,business ,030215 immunology ,Cohort study - Abstract
Central nervous system (CNS) involvement in Burkitt lymphoma (BL) poses a major therapeutic challenge, and the relative ability of contemporary regimens to treat CNS involvement remains uncertain. We described prognostic significance of CNS involvement and incidence of CNS recurrence/progression after contemporary immunochemotherapy using real-world clinicopathologic data on adults with BL diagnosed between 2009 and 2018 across 30 US institutions. We examined associations between baseline CNS involvement, patient characteristics, complete response (CR) rates, and survival. We also examined risk factors for CNS recurrence. Nineteen percent (120/641) of patients (age 18-88 years) had CNS involvement. It was independently associated with HIV infection, poor performance status, involvement of ≥2 extranodal sites, or bone marrow involvement. First-line regimen selection was unaffected by CNS involvement (P=0.93). Patients with CNS disease had significantly lower rates of CR (59% versus 77% without; P
- Published
- 2021
43. Ixazomib, Oral Metronomic Cyclophosphamide, and Dexamethasone for First-Line Treatment of Multiple Myeloma: A Phase II Brown University Oncology Group Study
- Author
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Ari Pelcovits, Peter Barth, John L Reagan, Adam J Olszewski, Vallerie Rosati, Roxanne Wood, Ashlee Sturtevant, and Eric S Winer
- Subjects
Cancer Research ,Oncology - Abstract
Background Newly diagnosed multiple myeloma patients have many available treatment options. While lenalidomide, bortezomib, and dexamethasone (RVD) is the preferred initial treatment for many patients, several other agents may provide similar efficacy with less toxicity and improved ease of administration. Methods We evaluated the safety and efficacy of the all-oral regimen of ixazomib, cyclophosphamide, and dexamethasone with the use of metronomic cyclophosphamide dosing in the treatment of patients with newly diagnosed multiple myeloma. Results The study was stopped prior to planned enrollment due to slow recruitment, with 12 patients available for final analysis. The overall response rate was 58.3% with 2 patients achieving a very good partial response (16.7%) and 5 patients achieving a partial response (41.7%). Median progression-free survival was 16 months, and median overall survival was 43 months. There were no episodes of grade 3 or greater peripheral neuropathy. Grade 3 or greater dermatologic toxicity was experienced in 50% of patients. Conclusion Although limited enrollment prevented full efficacy evaluation, our data do not support further study of metronomic cyclophosphamide in combination with ixazomib and dexamethasone in the treatment of newly diagnosed multiple myeloma. The activity of this regimen in the relapsed/refractory setting requires further study (ClinicalTrials.gov Identifier: NCT02412228).
- Published
- 2023
44. Prognostication and Treatment of Burkitt Lymphoma in the Modern Era
- Author
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Adam J. Olszewski
- Subjects
Immunoglobulin gene ,Cancer Research ,business.industry ,medicine.medical_treatment ,Hematology ,Cell cycle ,medicine.disease ,Targeted therapy ,Lymphoma ,Oncology ,CDKN2A ,hemic and lymphatic diseases ,TCF3 ,medicine ,Cancer research ,Rituximab ,business ,Transcription factor ,medicine.drug - Abstract
Introduction Burkitt lymphoma (BL) is an ultra-aggressive B-cell lymphoma which represents ~1% of adult and ~30% of pediatric lymphomas.1 Apart from the sporadic variant predominant in the United States (US), BL may occur as immunodeficiency-associated or endemic variants. BL is curable in most patients with short-course, dose-intense immunochemotherapy. Molecular underpinning of BL has been well understood, but not yet translated into targeted therapy. About 90% show MYC rearrangement with an immunoglobulin gene (the classical IGH-MYC t(8;14), IGK, or IGL) but otherwise BL has fewer karyotypic abnormalities than other high-grade lymphomas. Commonly mutated genes include the centroblastic transcription factor TCF3 (25%, activating mutations) or its inhibitor ID3 (60%, inactivating mutations), cell cycle regulators CCND3 (30%) and CDKN2A/B (10%), as well as TP53 (35%).2 Of note, tonic PI3K-AKT-mTOR signaling contributes to BL sustained cell survival. The prognostic impact of specific molecular features remains undefined.
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- 2021
45. Early Palliative Care Services and End-of-Life Care in Medicare Beneficiaries with Hematologic Malignancies: A Population-Based Retrospective Cohort Study
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Pamela C Egan, Thomas W. LeBlanc, Vinay Rao, Adam J. Olszewski, and Emmanuelle Belanger
- Subjects
medicine.medical_specialty ,Aggressive care ,Palliative care ,Population ,Population based ,Medicare ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,030502 gerontology ,medicine ,Surveillance, Epidemiology, and End Results ,Humans ,Prospective Studies ,Intensive care medicine ,education ,General Nursing ,Aged ,Retrospective Studies ,Terminal Care ,education.field_of_study ,business.industry ,Palliative Care ,Medicare beneficiary ,Retrospective cohort study ,Original Articles ,General Medicine ,United States ,humanities ,Anesthesiology and Pain Medicine ,Hematologic Neoplasms ,030220 oncology & carcinogenesis ,Female ,0305 other medical science ,business ,End-of-life care - Abstract
Background: Patients with hematologic malignancies (HM) often receive aggressive care at the end of life (EOL). Early palliative care (PC) has been shown to improve EOL care outcomes, but its benefits are less established in HM than in solid tumors. Objectives: We sought to describe the use of billed PC services among Medicare beneficiaries with HM. We hypothesized that receipt of early PC services (rendered >30 days before death) may be associated with less aggressive EOL care. Design: Retrospective cohort analysis Setting/Subjects: Using the Surveillance, Epidemiology, and End Results-Medicare registry, we studied patients with leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm who died between 2001 and 2015. Measurements: We described trends in the use of PC services and evaluated the association between early PC services and metrics of EOL care aggressiveness. Results: Among 139,191 decedents, the proportion receiving PC services increased from 0.4% in 2001 to 13.3% in 2015. Median time from first encounter to death was 10 days and 84.3% of encounters occurred during hospitalizations. In patients who survived >30 days from diagnosis (N = 120,741), the use of early PC services was more frequent in acute leukemia, women, and black patients, among other characteristics. Early PC services were associated with increased hospice use and decreased health care utilization at the EOL. Conclusion: Among patients with HM, there was an upward trend in PC services, and early PC services were associated with less aggressive EOL care. Our results support the need for prospective trials of early PC in HM.
- Published
- 2021
46. The Burkitt Lymphoma International Prognostic Index (BL-IPI)
- Author
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Andreas K. Klein, Deepa Jagadeesh, Tarec Christoffer El-Galaly, Umar Farooq, Catherine Zhu, Nicolas Martinex-Calle, Craig A. Portell, Xiao-Yin Zhang, Adam J. Olszewski, Manali Kamdar, Andrew M. Evens, Neil Palmisiano, Tycel Phillips, Nadia Khan, Chan Yoon Cheah, Stephen D. Smith, Catherine Diefenbach, Vaishalee P. Kenkre, Reem Karmali, Silvia Montoto, Izidore S. Lossos, Graham P. Collins, Lasse Hjort Jakobsen, Alexey V. Danilov, Adam Zayac, Alina S. Gerrie, Matthew A. Lunning, Narendranath Epperla, Parameswaran Venugopal, Knut B. Smeland, Scott E. Smith, Kirsten M Boughan, Maryam Sarraf Yazdy, Suchitra Sundaram, Peter Martin, Kevin A. David, Anna Santarsieri, Alessia Dalla Pria, Nishitha Reddy, Seema Naik, Veronika Bachanova, Kristie A. Blum, David Peace, Kate Cwynarski, Elizabeth H Phillips, Shireen Kassam, Mark Bower, Tatyana Feldman, and Fredrik Ellin
- Subjects
Oncology ,medicine.medical_specialty ,International Prognostic Index ,business.industry ,Internal medicine ,Immunology ,medicine ,Cell Biology ,Hematology ,medicine.disease ,business ,Biochemistry ,Lymphoma - Abstract
Background. BL is a rare, high-grade B-cell lymphoma that is often studied in trials with small sample sizes. Historical definitions of "low-risk BL" vary between studies, use arbitrary cutoffs for lactate dehydrogenase (LDH), and identify a small favorable group, leaving >80-90% of patients (pts) in an undifferentiated "high-risk" category. A validated prognostic index will help compare study cohorts and better define good-prognosis pts for whom reduced treatment would be appropriate vs a poor-prognosis group in need of new approaches. Herein, we constructed and validated a simplified prognostic model for BL applicable to diverse clinical settings across the world. Methods. We derived the BL-IPI from a large real-world evidence cohort of US adults treated for BL in 2009-2018 (Evens A, Blood 2020). Progression-free survival (PFS) from diagnosis until BL recurrence, progression, death, or censoring was the primary outcome. We first determined the best prognostic cutoffs for age, LDH (normalized to local upper limit normal, ULN), hemoglobin (Hgb), and albumin. Independent risk factors were ascertained by forward stepwise selection into Cox regression from candidate variables: age, sex, HIV+ status, ECOG performance status (PS) ≥2, advanced stage (3/4), involvement of >1 extranodal site, bone marrow, central nervous system (CNS), values of LDH, Hgb, and albumin. Derivation models used multiple imputation to mitigate bias from missing data and reported hazard ratios (HR) with 95% confidence interval (CI). BL-IPI groups, defined by inspection of survival curves, were compared using log-rank test for trend. We validated performance of the BL-IPI in an external retrospective dataset of BL pts treated contemporaneously in centers from the United Kingdom, Scandinavia, Canada, and Australia. Results. Characteristics of pts in the derivation (N= 633) and validation (N=457) cohorts are shown in the Table. Age ≥40 years (yr), LDH >3xULN, Hgb 3xULN, low Hgb, and low albumin were associated with inferior PFS in univariate tests. In the multivariable model age ≥40 yr, LDH >3xULN, PS ≥2, and CNS involvement were selected as 4 independent prognostic factors; adding stage did not enhance the model. The model was simplified to 3 groups with 0 (low risk; 18% of pts), 1 (intermediate risk; 36% of pts; HR=3.14; 95%CI, 1.61-6.14), or 2-4 factors (high risk; 46% of pts; HR=6.52; 95%CI, 3.48-12.20; Fig A) with 3 yr PFS of 92%, 72%, and 53%, respectively (P Among pts with stage III/IV (historically classified as "high-risk" and constituting 78% of all pts in the cohort), the BL-IPI further discriminated subgroups with 3 yr PFS of 87%, 71%, and 52%, respectively (P In the international validation cohort, fewer pts had CNS involvement; most received CODOX-M/IVAC+R; and PFS/OS estimates at 3 yr were higher. BL-IPI categories were of similar size (low-risk 15%, intermediate-risk 35%, high-risk 50%), and provided similar risk discrimination (Harrell's C=.65 in both datasets). PFS at 3 yr was 96%, 82%, and 63%, respectively (P Conclusions. BL-IPI is a novel prognostic index specific to BL, which was validated to allow for simplified stratification and comparison of risk distribution in geographically diverse cohorts. The index identified a low-risk group with PFS >90-95%, which could be targeted with future strategies for treatment de-escalation. Conversely, only about 55-60% of pts in the high-risk group achieved cure with currently available immunochemotherapy. Disclosures Olszewski: Spectrum Pharmaceuticals: Research Funding; Genentech, Inc.: Research Funding; TG Therapeutics: Research Funding; Adaptive Biotechnologies: Research Funding. Jakobsen:Takeda: Honoraria. Collins:ADC Therapeutics: Consultancy, Honoraria; Celleron: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Speakers Bureau; Amgen: Research Funding; BeiGene: Consultancy; BMS: Consultancy, Honoraria, Research Funding, Speakers Bureau; Gilead: Consultancy, Honoraria, Speakers Bureau; MSD: Consultancy, Honoraria, Research Funding; Taekda: Consultancy, Honoraria, Other: travel, accommodations, expenses, Speakers Bureau; Roche: Consultancy, Honoraria, Other: travel, accommodations, expenses , Speakers Bureau; Pfizer: Honoraria; Celgene: Research Funding. Cwynarski:Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support; Atara: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; KITE: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support, Speakers Bureau; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support, Speakers Bureau; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support, Speakers Bureau. Bachanova:Incyte: Research Funding; Karyopharma: Membership on an entity's Board of Directors or advisory committees; BMS: Research Funding; FATE: Research Funding; Kite: Membership on an entity's Board of Directors or advisory committees; Gamida Cell: Membership on an entity's Board of Directors or advisory committees, Research Funding. Danilov:Abbvie: Consultancy; BeiGene: Consultancy; Nurix: Consultancy; Celgene: Consultancy; Gilead Sciences: Research Funding; Takeda Oncology: Research Funding; Pharmacyclics: Consultancy; Bayer Oncology: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; TG Therapeutics: Consultancy; Astra Zeneca: Consultancy, Research Funding; Verastem Oncology: Consultancy, Research Funding; Karyopharm: Consultancy; Aptose Biosciences: Research Funding; Bristol-Myers Squibb: Research Funding; Rigel Pharmaceuticals: Consultancy. Diefenbach:Trillium: Research Funding; Millenium/Takeda: Research Funding; MEI: Research Funding; Merck: Consultancy, Research Funding; Seattle Genetics: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Genentech, Inc.: Consultancy, Research Funding; Incyte: Research Funding; LAM Therapeutics: Research Funding; Denovo: Research Funding. Epperla:Pharmacyclics: Honoraria; Verastem Oncology: Speakers Bureau. Farooq:Kite, a Gilead Company: Honoraria. Feldman:Pfizer: Research Funding; Portola: Research Funding; Janssen: Speakers Bureau; AstraZeneca: Consultancy; Cell Medica: Research Funding; Seattle Genetics, Inc.: Consultancy, Honoraria, Other: Travel expenses, Research Funding, Speakers Bureau; Viracta: Research Funding; Trillium: Research Funding; Rhizen: Research Funding; Corvus: Research Funding; BMS: Consultancy, Honoraria, Research Funding; Kite: Honoraria, Other: Travel expenses, Speakers Bureau; Celgene: Honoraria, Research Funding; Takeda: Honoraria, Other: Travel expenses; Amgen: Research Funding; Pharmacyclics: Honoraria, Other, Speakers Bureau; Abbvie: Honoraria; Bayer: Consultancy, Honoraria; Eisai: Research Funding; Kyowa Kirin: Consultancy, Research Funding. Gerrie:AbbVie: Consultancy, Honoraria, Research Funding; Astrazeneca: Consultancy, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Roche: Research Funding; Sandoz: Consultancy. Jagadeesh:Regeneron: Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Debiopharm Group: Research Funding; MEI Pharma: Research Funding; Verastem: Membership on an entity's Board of Directors or advisory committees. Kamdar:BMS: Consultancy; Abbvie: Consultancy; Karyopharm: Consultancy; Celgene: Consultancy; AstraZeneca: Consultancy; Pharmacyclics: Consultancy; Seattle Genetics: Speakers Bureau. Karmali:Takeda: Research Funding; AstraZeneca: Speakers Bureau; BeiGene: Speakers Bureau; Karyopharm: Honoraria; BMS/Celgene/Juno: Honoraria, Other, Research Funding, Speakers Bureau; Gilead/Kite: Honoraria, Other, Research Funding, Speakers Bureau. Khan:Seattle Genetics: Research Funding; Janssen: Honoraria; Pharmacyclics: Honoraria; Bristol Myers Squibb: Research Funding; Celgene: Research Funding. Klein:Takeda: Membership on an entity's Board of Directors or advisory committees. Lossos:Verastem: Consultancy, Honoraria; Stanford University: Patents & Royalties; Seattle Genetics: Consultancy, Other; Janssen Biotech: Honoraria; NCI: Research Funding; Janssen Scientific: Consultancy, Other. Lunning:ADC Therapeutics: Consultancy; Legend: Consultancy; Acrotech: Consultancy; AstraZeneca: Consultancy, Honoraria; Aeratech: Consultancy, Honoraria; Beigene: Consultancy, Honoraria; Verastem: Consultancy, Honoraria; TG Therapeutics: Research Funding; Novartis: Consultancy, Honoraria; Kite: Consultancy, Honoraria; Karyopharm: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Curis: Research Funding; Bristol Meyers Squibb: Consultancy, Honoraria, Research Funding. Martin:I-MAB: Consultancy; Celgene: Consultancy; Teneobio: Consultancy; Karyopharm: Consultancy, Research Funding; Janssen: Consultancy; Sandoz: Consultancy; Bayer: Consultancy; Beigene: Consultancy; Cellectar: Consultancy; Incyte: Consultancy; Kite: Consultancy; Morphosys: Consultancy; Regeneron: Consultancy. Martinex-Calle:Abbvie: Other: Travel grant. Naik:Celgene: Other: advisory board; Sanofi: Other: advisory board. Palmisiano:Genentech: Research Funding; AbbVie: Research Funding. Phillips:Beigene: Honoraria; Roche: Research Funding. Phillips:Seattle Genetics: Consultancy; Incyte: Consultancy, Other: travel expenses; AstraZeneca: Consultancy; Karyopharm: Consultancy; Beigene: Consultancy; Bayer: Consultancy, Research Funding; BMS: Consultancy; Pharmacyclics: Consultancy; Abbvie: Consultancy, Research Funding; Cardinal Health: Consultancy. Portell:Roche/Genentech: Consultancy, Research Funding; Infinity: Research Funding; Bayer: Consultancy; Amgen: Consultancy; TG Therapeutics: Research Funding; AbbVie: Research Funding; Pharmacyclics: Consultancy; Janssen: Consultancy; Kite: Consultancy, Research Funding; Acerta/AstraZeneca: Research Funding; Xencor: Research Funding; BeiGene: Consultancy, Research Funding. Reddy:Celgene: Consultancy; BMS: Consultancy, Research Funding; Genentech: Research Funding; Abbvie: Consultancy; KITE Pharma: Consultancy. Yazdy:Abbvie: Consultancy; Genentech: Research Funding; Octapharma: Consultancy; Bayer: Honoraria. Smith:Bristol Meyers Squibb: Research Funding; Ayala: Research Funding; Seattle Genetics: Research Funding; Portola: Research Funding; Pharmacyclics: Research Funding; Merck: Research Funding; Incyte: Research Funding; Ignyta: Research Funding; Genentech: Research Funding; De Novo Biopharma: Research Funding; AstraZeneca: Consultancy; Millenium/Takeda: Consultancy; Beigene: Consultancy; Bayer: Research Funding; AstraZeneca: Research Funding; Acerta Pharma BV: Research Funding; Karyopharm: Consultancy. Cheah:Celgene, F. Hoffmann-La Roche, Abbvie, MSD: Research Funding; Celgene, F. Hoffmann-La Roche, MSD, Janssen, Gilead, Ascentage Pharma, Acerta, Loxo Oncology, TG therapeutics: Honoraria. El-Galaly:F. Hoffmann-La Roche: Current Employment, Other: Support of parent study and funding of editorial support. Evens:Research To Practice: Honoraria, Speakers Bureau; Mylteni: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria, Research Funding; Pharmacyclics: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Merck: Consultancy, Honoraria, Research Funding; Epizyme: Consultancy, Honoraria, Research Funding; MorphoSys: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria.
- Published
- 2020
47. Coinfections in Patients With Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Study
- Author
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Gowri Satyanarayana, Kyle T Enriquez, Tianyi Sun, Elizabeth J Klein, Maheen Abidi, Shailesh M Advani, Joy Awosika, Ziad Bakouny, Babar Bashir, Stephanie Berg, Marilia Bernardes, Pamela C Egan, Arielle Elkrief, Lawrence E Feldman, Christopher R Friese, Shipra Goel, Cyndi Gonzalez Gomez, Keith L Grant, Elizabeth A Griffiths, Shuchi Gulati, Shilpa Gupta, Clara Hwang, Jayanshu Jain, Chinmay Jani, Anna Kaltsas, Anup Kasi, Hina Khan, Natalie Knox, Vadim S Koshkin, Daniel H Kwon, Chris Labaki, Gary H Lyman, Rana R McKay, Christopher McNair, Gayathri Nagaraj, Elizabeth S Nakasone, Ryan Nguyen, Taylor K Nonato, Adam J Olszewski, Orestis A Panagiotou, Matthew Puc, Pedram Razavi, Elizabeth V Robilotti, Miriam Santos-Dutra, Andrew L Schmidt, Dimpy P Shah, Sumit A Shah, Kendra Vieira, Lisa B Weissmann, Trisha M Wise-Draper, Ulysses Wu, Julie Tsu-Yu Wu, Toni K Choueiri, Sanjay Mishra, Jeremy L Warner, Benjamin French, and Dimitrios Farmakiotis
- Subjects
viral infections ,Prevention ,COVID-19 ,CAPA ,mucormycoses ,Emerging Infectious Diseases ,Good Health and Well Being ,Infectious Diseases ,bacterial infections ,Oncology ,Clinical Research ,2.2 Factors relating to the physical environment ,Aetiology ,Infection ,Lung ,Cancer - Abstract
Background The frequency of coinfections and their association with outcomes have not been adequately studied among patients with cancer and coronavirus disease 2019 (COVID-19), a high-risk group for coinfection. Methods We included adult (≥18 years) patients with active or prior hematologic or invasive solid malignancies and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, using data from the COVID-19 and Cancer Consortium (CCC19, NCT04354701). We captured coinfections within ±2 weeks from diagnosis of COVID-19, identified factors cross-sectionally associated with risk of coinfection, and quantified the association of coinfections with 30-day mortality. Results Among 8765 patients (hospitalized or not; median age, 65 years; 47.4% male), 16.6% developed coinfections: 12.1% bacterial, 2.1% viral, 0.9% fungal. An additional 6.4% only had clinical diagnosis of a coinfection. The adjusted risk of any coinfection was positively associated with age >50 years, male sex, cardiovascular, pulmonary, and renal comorbidities, diabetes, hematologic malignancy, multiple malignancies, Eastern Cooperative Oncology Group Performance Status, progressing cancer, recent cytotoxic chemotherapy, and baseline corticosteroids; the adjusted risk of superinfection was positively associated with tocilizumab administration. Among hospitalized patients, high neutrophil count and C-reactive protein were positively associated with bacterial coinfection risk, and high or low neutrophil count with fungal coinfection risk. Adjusted mortality rates were significantly higher among patients with bacterial (odds ratio [OR], 1.61; 95% CI, 1.33–1.95) and fungal (OR, 2.20; 95% CI, 1.28–3.76) coinfections. Conclusions Viral and fungal coinfections are infrequent among patients with cancer and COVID-19, with the latter associated with very high mortality rates. Clinical and laboratory parameters can be used to guide early empiric antimicrobial therapy, which may improve clinical outcomes.
- Published
- 2022
48. Outcomes of lenalidomide‐ or bortezomib‐based regimens in older patients with plasma cell myeloma
- Author
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Adam J. Olszewski, John L. Reagan, Smith Giri, and Peter Barth
- Subjects
Male ,Oncology ,medicine.medical_specialty ,Cyclophosphamide ,Anemia ,Dexamethasone ,Disease-Free Survival ,Bortezomib ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Adverse effect ,Lenalidomide ,Aged ,Aged, 80 and over ,business.industry ,Hazard ratio ,Hematology ,medicine.disease ,Survival Rate ,Regimen ,030220 oncology & carcinogenesis ,Female ,Multiple Myeloma ,business ,030215 immunology ,medicine.drug - Abstract
The "triplet" regimen of lenalidomide, bortezomib, and dexamethasone (RVD) showed survival advantage over lenalidomide-dexamethasone (RD) in clinical trials, but older patients with myeloma often receive doublet regimens (RD or bortezomib-dexamethasone, VD), or VD plus cyclophosphamide (VCD). We compared these first-line regimens using real-world data from Medicare beneficiaries receiving therapy between 2007 and 2015. In each comparative analysis, we balanced confounding characteristics using a propensity score. Outcomes included overall (OS) and event-free survival (EFS, reporting hazard ratios [HR] with 95% confidence intervals [CI]), adverse events, and costs. We identified 6076 patients with median age 76 and median OS of 2.6 years. In the comparison of RVD vs RD/VD doublets, RVD showed significantly better OS (HR = 0.83; 95% CI, 0.72-0.95) and EFS (HR = 0.68; 95% CI, 0.61-0.76). So, RVD was associated with more frequent hospitalizations, anemia, and neuropathy, but no increase in thromboembolism or secondary cancers. Costs were higher with RVD. In the comparison of RD vs VD, RD demonstrated better EFS (HR = 0.74; 95% CI, 0.68-0.81) and marginally better OS (HR = 0.91; 95% CI, 0.83-0.99). And, RD resulted in significantly more thromboembolic events, less neuropathy, and no significant difference in hospitalizations, transfusions, or secondary cancers. In the comparison of VCD vs VD, we observed no significant difference in any outcome. Superior survival favors RVD over doublet regimens, but even in 2015 RVD was applied for only about 25% of Medicare beneficiaries with myeloma. For patients not eligible for RVD due to toxicity, VCD offers no survival benefit over VD. Lenalidomide-dexamethasone may be the preferred line doublet considering its advantage over VD.
- Published
- 2020
49. Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study
- Author
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Zhuoer Xie, Julie T Wu, Huili Zhu, Deborah B. Doroshow, Yu Shyr, Thorvardur R. Halfdanarson, Jessica Hawley, Sanjay Mishra, Lidia Schapira, Leslie A. Fecher, Sanjay Goel, Samuel M. Rubinstein, Petros Grivas, Pamela C Egan, Solange Peters, Sumit A. Shah, Gary K. Schwartz, Michael A. Thompson, Jonathan T Arcobello, Chih-Yuan Hsu, Christopher R. Friese, Dimitrios Farmakiotis, Corrie A. Painter, Matthew D. Galsky, Nicole M. Kuderer, Nathan A. Pennell, Ziad Bakouny, Sanjay G. Revankar, Brian I. Rini, Albert C. Yeh, Donna R. Rivera, Jeremy L. Warner, Dimpy P. Shah, Brendan J Lee, Ali Raza Khaki, Adam J. Olszewski, Matthew Puc, Orestis A. Panagiotou, Gary H. Lyman, Christopher Lemmon, Balazs Halmos, Andrew Schmidt, Toni K. Choueiri, Gilberto Lopes, Shilpa Gupta, and COVID-19 and Cancer Consortium
- Subjects
Male ,0301 basic medicine ,Logistic regression ,Severity of Illness Index ,0302 clinical medicine ,Risk Factors ,Neoplasms ,Hospital Mortality ,Research Articles ,Alanine ,Age Factors ,Middle Aged ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Drug Therapy, Combination ,Coronavirus Infections ,Hydroxychloroquine ,Cohort study ,medicine.drug ,medicine.medical_specialty ,Clinical Decision-Making ,Pneumonia, Viral ,Betacoronavirus ,03 medical and health sciences ,Sex Factors ,Pharmacotherapy ,Internal medicine ,Statistical significance ,Severity of illness ,medicine ,Humans ,Healthcare Disparities ,Glucocorticoids ,Pandemics ,Aged ,Adenosine Monophosphate/analogs & derivatives ,Adenosine Monophosphate/therapeutic use ,Alanine/analogs & derivatives ,Alanine/therapeutic use ,Betacoronavirus/pathogenicity ,Coronavirus Infections/complications ,Coronavirus Infections/diagnosis ,Coronavirus Infections/drug therapy ,Coronavirus Infections/mortality ,Drug Therapy, Combination/methods ,Drug Therapy, Combination/statistics & numerical data ,Drug Utilization/statistics & numerical data ,Follow-Up Studies ,Glucocorticoids/therapeutic use ,Healthcare Disparities/statistics & numerical data ,Hydroxychloroquine/therapeutic use ,Neoplasms/complications ,Neoplasms/mortality ,Pneumonia, Viral/complications ,Pneumonia, Viral/diagnosis ,Pneumonia, Viral/drug therapy ,Pneumonia, Viral/mortality ,United States/epidemiology ,SARS-CoV-2 ,business.industry ,COVID-19 ,Cancer ,medicine.disease ,Adenosine Monophosphate ,Drug Utilization ,United States ,COVID-19 Drug Treatment ,030104 developmental biology ,Observational study ,business - Abstract
In a large observational study in patients with COVID-19 and cancer, survival was not significantly influenced by receipt of COVID-19 treatments, except hydroxychloroquine plus any other treatment, which was associated with reduced survival., Among 2,186 U.S. adults with invasive cancer and laboratory-confirmed SARS-CoV-2 infection, we examined the association of COVID-19 treatments with 30-day all-cause mortality and factors associated with treatment. Logistic regression with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) was performed. Hydroxychloroquine with any other drug was associated with increased mortality versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated controls; this association was not present with hydroxychloroquine alone. Remdesivir had numerically reduced mortality versus untreated controls that did not reach statistical significance. Baseline COVID-19 severity was strongly associated with receipt of any treatment. Black patients were approximately half as likely to receive remdesivir as white patients. Although observational studies can be limited by potential unmeasured confounding, our findings add to the emerging understanding of patterns of care for patients with cancer and COVID-19 and support evaluation of emerging treatments through inclusive prospective controlled trials. Significance: Evaluating the potential role of COVID-19 treatments in patients with cancer in a large observational study, there was no statistically significant 30-day all-cause mortality benefit with hydroxychloroquine or high-dose corticosteroids alone or in combination; remdesivir showed potential benefit. Treatment receipt reflects clinical decision-making and suggests disparities in medication access. This article is highlighted in the In This Issue feature, p. 1426
- Published
- 2020
50. Adjuvant FOLFOX+Nab-Paclitaxel (FOLFOX-A) for Pancreatic Cancer
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Jennifer Renaud, Rimini Breakstone, Ashlee Sturtevant, Kevin P. Charpentier, Lindsey Cavanaugh, Adam J. Olszewski, Kara L. Leonard, Alexander G Raufi, Howard Safran, Khaldoun Almhanna, Rachel E. Beard, and Kelsey MacKinnon
- Subjects
Adult ,Male ,Oncology ,Cancer Research ,medicine.medical_specialty ,Maximum Tolerated Dose ,Organoplatinum Compounds ,Paclitaxel ,FOLFIRINOX ,Leucovorin ,Phases of clinical research ,Neutropenia ,03 medical and health sciences ,0302 clinical medicine ,FOLFOX ,Albumins ,Pancreatic cancer ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Medicine ,030212 general & internal medicine ,Adverse effect ,Aged ,business.industry ,Middle Aged ,medicine.disease ,digestive system diseases ,Gemcitabine ,Oxaliplatin ,Pancreatic Neoplasms ,Treatment Outcome ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Female ,Fluorouracil ,business ,Carcinoma, Pancreatic Ductal ,medicine.drug - Abstract
Objectives Multiple clinical trials have established a role for adjuvant chemotherapy for patients with pancreatic ductal adenocarcinoma. Adjuvant FOLFIRINOX increases survival as compared with gemcitabine but with increased toxicity. FOLFOX+nab-paclitaxel (FOLFOX-A) was developed by the Brown University Oncology Research Group (BrUOG) as an alternative to FOLFIRINOX. This phase II trial explored the feasibility and toxicity of adjuvant FOLFOX-A in patients who have completed resection for pancreatic ductal adenocarcinoma. Patients and methods Patients with resected pancreatic ductal adenocarcinoma were eligible. The primary objective was to determine the feasibility of adjuvant FOLFOX-A. Patients experiencing grade 2 neuropathy received a 20% reduction of oxaliplatin. Secondary end points were disease-free survival, and overall survival. Results Between June 2014 and October 2018, 25 patients were enrolled following surgical resection. The median number of cycles completed was 9.5. Median disease-free survival was 19.7 months (95% confidence interval, 10.3 to not reached) and median overall survival was 53.5 months (95% confidence interval, 24.2 to not reached). The most common treatment-related grade 3 or greater adverse events were fatigue (58%), nausea (13%), and neutropenia (26%). Fourteen patients had grade 2 neuropathy (58%) and 1 patient (4%) had grade 3 neuropathy. Only 2 patients (8%) had grade 3 diarrhea. Conclusions Adjuvant FOLFOX-A is a feasible multi-agent adjuvant treatment regimen and, with further validation, could be an alternative to FOLFIRINOX.
- Published
- 2020
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