110 results on '"Srinivas Devarakonda"'
Search Results
2. Racial differences as predictors of outcomes in young patients with multiple myeloma
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Alicia Bao, Qiuhong Zhao, Elizabeth Merritt, Naresh Bumma, Srinivas Devarakonda, Abdullah M. Khan, Elvira Umyarova, Ashley E. Rosko, Don M. Benson, and Francesca Cottini
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2022
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3. AL amyloidosis: The effect of fluorescent in situ hybridization abnormalities on organ involvement and survival
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Michael Ozga, Qiuhong Zhao, Don Benson Jr., Patrick Elder, Nita Williams, Naresh Bumma, Ashley Rosko, Maria Chaudhry, Abdullah Khan, Srinivas Devarakonda, Rami Kahwash, Ajay Vallakati, Courtney Campbell, Samir V. Parikh, Salem Almaani, Jason Prosek, Jordan Bittengle, Katherine Pfund, Samantha LoRusso, Miriam Freimer, Elyse Redder, Yvonne Efebera, and Nidhi Sharma
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amyloidosis ,fluorescent in situ hybridization ,light‐chain amyloidosis ,myeloma ,plasma cell burden ,survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Systemic light chain (AL) amyloidosis is a clonal plasma‐cell neoplasm that carries a poor prognosis. Although AL amyloidosis and Multiple Myeloma (MM) can co‐exist and share various cytogenetic chromosomal abnormalities, little is known about Fluorescent in situ hybridization (FISH) and its prognostic relevance in AL amyloidosis. Aim: The study aims to evaluate the most prevalent FISH cytogenetic abnormalities in AL patients as independent prognostic factors, and assess the impact of cytogenetics on the survival of high‐risk cardiac AL patients. Materials & Methods This retrospective study reviewed 113 consecutive AL patients treated at The Ohio State University (OSU). Patients were divided into subgroups based on FISH data obtained within 90 days of diagnosis. Hyperdiploidy was defined as trisomies of at least 2 chromosomal loci. Primary endpoints were progression free survival (PFS) and overall survival (OS). Kaplan Meier curves were used to calculate PFS and OS. The log‐rank test and Cox proportional hazard models were used to test the equality of survival functions and further evaluate the differences between groups. Results FISH abnormalities were detected in 76% of patients. Patients with abnormal FISH trended toward lower overall survival (OS) (p=0.06) and progression free survival (PFS) (p=0.06). The two most prevalent aberrations were translocation t(11;14) (39%) and hyperdiploidy‐overall (38%). Hyperdiploidy‐overall was associated with worsening PFS (p=0.018) and OS (p=0.03), confirmed in multivariable analysis. Patients with del 13q most frequently had cardiac involvement (p=0.006) and was associated with increased bone marrow plasmacytosis (p=0.02). Cardiac AL patients with no FISH abnormalities had much improved OS (p=0.012) and PFS (p=0.018) Conclusions Our findings ultimately reveal the association of hyperdiploidy on survival in AL amyloidosis patients, including the high‐risk cardiac AL population.
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- 2021
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4. Incidence, Treatment, and Survival of Patients With T-Cell Lymphoma, T-Cell Large Granular Leukemia, and Concomitant Plasma Cell Dyscrasias
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Zachary Braunstein, Eric McLaughlin, Miguel Ruiz, Lai Wei, Naresh Bumma, Don Benson, Srinivas Devarakonda, Maria Chaudhry, Abdullah Khan, Francesca Cottini, Walter Hanel, Robert Baiocchi, Catherine Chung, Daniel Addison, Nina Couette, Alexa Meara, Wael Jarjour, Pierluigi Porcu, Anjali Mishra, John C. Reneau, Ashley E. Rosko, and Jonathan E. Brammer
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T cell ,CTCL ,T-LGL ,PTCL ,MGUS ,multiple myeloma ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
T-Cell malignancies are a group of heterogeneous disorders composed of primary cutaneous T-cell lymphomas (CTCLs), peripheral T-cell lymphomas (PTCLs), and T-cell leukemias, including T-cell large granular lymphocytic leukemia (T-LGLL). Cases of patients with combined T-cell malignancies and plasma cell dyscrasias (PCD) are reported in the literature, but these are mostly limited to case reports or small case series with
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- 2022
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5. Impact of Race and Geographic Area of Residence on Outcomes After Allogeneic Stem Cell Transplant
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Audrey M. Sigmund, Qiuhong Zhao, Justin Jiang, Patrick Elder, Don M. Benson, Ashley Rosko, Naresh Bumma, Abdullah Khan, Srinivas Devarakonda, Sumithira Vasu, Samantha Jaglowski, Alice Mims, Hannah Choe, Karilyn Larkin, Jonathan Brammer, Sarah Wall, Nicole Grieselhuber, Ayman Saad, Sam Penza, Yvonne A. Efebera, and Nidhi Sharma
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race ,geographic location of residence ,allogeneic transplant ,health disparities ,GvHD ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundAllogeneic hematopoietic stem cell transplant (allo-HCT) is a potential curative therapy for a variety of hematologic disorders. However, it requires highly specialized care that is only available at select centers across the country. Thus, minority populations are at risk for healthcare disparities in access to and outcomes of allo-HCT. Our study aimed to assess the impact of race and location of residence on outcomes of allo-HCT.MethodsWe performed a retrospective analysis of all patients who underwent allo-HCT at the Ohio State University from 1984 to 2018. Patients were divided by race (Caucasian, African American, and other) and grouped by zip code into rural, suburban, and urban groups. Primary endpoints included progression-free survival (PFS) and overall survival (OS).ResultsOf the 1,943 patients included in the study, 94.3% self-identified as Caucasian, 4.6% African American, and 1.1% other. In total, 63.4% lived in rural areas, 22.9% suburban, and 13.8% urban. There was no significant difference in OS or PFS by race (p = 0.15, 0.21) or place of residence (p = 0.39, 0.17). In addition, no difference in nonrelapse mortality, acute and chronic graft-versus-host disease (GVHD), and GVHD-free relapse-free survival (GRFS) was seen among the race or place of residence.ConclusionOur study suggests that when appropriate access to HCT is given, there is no difference in outcomes based on race, ethnicity or place of primary residence. Further research is needed to further evaluate barriers for these patients to undergo transplant and help mitigate these barriers.
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- 2022
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6. Nodular pulmonary deposition disease in a patient with the acquired immunodeficiency syndrome: a case report
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Jessica N. Mezzanotte, I-Sanna Gibbons-Fideler, Konstantin Shilo, Mark Lustberg, and Srinivas Devarakonda
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Light chain deposition disease (LCDD) ,AIDS ,HIV ,Hypergammaglobulinemia ,Medicine - Abstract
Abstract Background Pulmonary nodules are a common cause for concern in patients with human immunodeficiency virus and acquired immunodeficiency syndrome. Most commonly, they are the result of an infection, given the patients’ immunocompromised state; however, in some cases, pulmonary nodules in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome can result from cellular or protein deposits. We report a rare case of nodular pulmonary light chain deposition disease in a patient with acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance. Case presentation A 53-year-old African American woman with acquired immunodeficiency syndrome had pulmonary nodules detected incidentally by imaging of her lungs. Pulmonary tuberculosis was high on the differential diagnosis, but she had a negative test result for pulmonary tuberculosis. Imaging also revealed multiple lucent bone lesions, and earlier in the year, serum protein electrophoresis had shown an immunoglobulin G-kappa monoclonal protein (M spike). She was mildly anemic, so there was concern for progression to myeloma; however, the result of her bone marrow biopsy was unremarkable. Lung biopsy revealed finely granular eosinophilic material with negative Congo red staining, consistent with light chain deposition disease. Conclusions The extent of this patient’s light chain deposition disease was thought to be caused by a combination of acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance, and the interval decrease in lung nodule size after restarting antiretroviral therapy confirms this hypothesis and also highlights a potentially unique contribution of the hypergammaglobulinemia to this disease process in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome .
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- 2020
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7. Real World Experience of Daratumumab: Evaluating Lymphopenia and Adverse Events in Multiple Myeloma Patients
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Francesca Cottini, Ying Huang, Nita Williams, Naresh Bumma, Abdullah M. Khan, Maria Chaudhry, Srinivas Devarakonda, Yvonne A. Efebera, Don M. Benson, and Ashley E. Rosko
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myeloma ,daratumumab ,lymphopenia ,infections ,outcomes ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Multiple myeloma (MM) is an incurable disease with a limited life expectancy of five years from diagnosis. Uncontrolled disease or infections are the main causes of mortality. Daratumumab, a monoclonal antibody against CD38, is approved to treat patients with MM. Its target, CD38, is expressed not only on MM cells but also on common lymphoid precursors and subsets of normal lymphocytes. Daratumumab-induced lymphopenia is common, but its clinical significance is understudied. In this study, we report the baseline characteristics, rates of severe lymphopenia, infections, and clinical trajectory of multiple myeloma patients (n = 100) treated with daratumumab-based regimens at the Ohio State University Comprehensive Cancer Center. We discover high rates of infections, hospital utilization, and severe lymphopenia and identify risks factors for severe lymphopenia, such as low pretreatment absolute lymphocyte count (ALC) values. Severe lymphopenia persists in 23% of patients, resulting in worst survival outcomes. Our data underline the importance of monitoring ALC and consider future use of prophylactic measures or alternative regimens in subsets of MM patients.
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- 2021
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8. InsideOut: Model to Predict Outside CO Concentrations from Mobile CO Dosimeter Measurements Inside Vehicles.
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Srinivas Devarakonda, Senthil Chittaranjan, Daehan Kwak, and Badri Nath
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- 2020
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9. Survival outcomes following autologous stem cell transplant with melphalan 140mg/m2 versus 200mg/m2 preparative regimens in patients with multiple myeloma
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Nidhi Sharma, Evan Benson, Qiuhong Zhao, Jordan Nunnelee, Francesca Cottini, Patrick Elder, Ashley Rosko, Naresh Bumma, Abdullah Khan, Elvira Umyarova, Srinivas Devarakonda, Yvonne A. Efebera, and Don M. Benson
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Cancer Research ,Oncology ,Hematology - Published
- 2023
10. Investigating Remote Driving over the LTE Network.
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Ruilin Liu, Daehan Kwak, Srinivas Devarakonda, Kostas E. Bekris, and Liviu Iftode
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- 2017
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11. NCCN Guidelines® Insights: Multiple Myeloma, Version 3.2022
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Natalie S. Callander, Muhamed Baljevic, Kehinde Adekola, Larry D. Anderson, Erica Campagnaro, Jorge J. Castillo, Caitlin Costello, Srinivas Devarakonda, Noura Elsedawy, Matthew Faiman, Alfred Garfall, Kelly Godby, Jens Hillengass, Leona Holmberg, Myo Htut, Carol Ann Huff, Malin Hultcrantz, Yubin Kang, Sarah Larson, Michaela Liedtke, Thomas Martin, James Omel, Douglas Sborov, Kenneth Shain, Keith Stockerl-Goldstein, Donna Weber, Ryan A. Berardi, Rashmi Kumar, and Shaji K. Kumar
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Oncology ,hemic and lymphatic diseases - Abstract
The NCCN Guidelines for Multiple Myeloma provide recommendations for diagnosis, initial workup, treatment, follow-up, and supportive care for patients with various plasma cell neoplasms, including multiple myeloma. These NCCN Guidelines Insights highlight some of the important updates/changes specific to the treatment of patients with multiple myeloma in the 2022 version of the guidelines.
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- 2022
12. Real-time air quality monitoring through mobile sensing in metropolitan areas.
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Srinivas Devarakonda, Parveen Sevusu, Hongzhang Liu, Ruilin Liu, Liviu Iftode, and Badri Nath
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- 2013
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13. Early versus Late Discontinuation of Maintenance Therapy in Multiple Myeloma
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Maria Chaudhry, Don M. Benson, Qiuhong Zhao, Naresh Bumma, Abdullah Khan, Jordan Nunnelee, Srinivas Devarakonda, Ashley E. Rosko, Patrick Elder, Muhammad Salman Faisal, Francesca Cottini, Nidhi Sharma, and Yvonne A. Efebera
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Oncology ,medicine.medical_specialty ,business.industry ,Immunology ,Cell Biology ,Hematology ,General Medicine ,medicine.disease ,Biochemistry ,Discontinuation ,multiple myeloma ,maintenance ,adverse events ,lenalidomide ,Maintenance therapy ,Internal medicine ,Medicine ,business ,Multiple myeloma - Abstract
Background: Indefinite maintenance therapy after autologous stem cell transplant (ASCT) is the current standard of care in multiple myeloma (MM). However, in the real world, patients often discontinue treatment due to various reasons. In this study, we sought to analyze the effect of and reasons for early discontinuation of maintenance therapy on survival outcomes, studying patients who received less than 3 years of maintenance therapy (short-term maintenance group) or more than 3 years (continuous maintenance group). Methods: We retrospectively reviewed 340 patients who underwent ASCT from 2005-2016 and received maintenance therapy for at least six months without progression. The patients started maintenance therapy after 100 days of ASCT. Lenalidomide (89%) and bortezomib (10%) were the most commonly used agents for maintenance therapy. The primary endpoints included were progression-free survival (PFS) and overall survival (OS). All the endpoints were measured from the time of ASCT. The discontinuation was defined as permanently stopping the maintenance therapy. Patient, disease, and transplant-related characteristics were compared between the two groups using the Mann-Whitney U test for continuous variables, and chi-squared or Fisher's exact test for categorical variables. The probabilities of PFS and OS were calculated using the Kaplan-Meier (KM) method and compared using log-rank test. Results: One hundred and two (n= 102; 30%) patients discontinued maintenance therapy in the first 3 years (short-term maintenance group), while 238 patients remained on maintenance therapy for ≥ 3 years (continuous maintenance group). The groups had similar baseline characteristics in terms of age, gender, ISS staging, cytogenetics, response before ASCT, and melphalan dosing. About 20% of patients in both groups were older than 65 years. Among those alive at the last contact, the median follow up were 5.4 years and 6.1 years for the short-term and continuous maintenance therapy group, respectively. At the time of the last follow-up, 131/238 (55%) patients in the continuous maintenance group were still on maintenance therapy. The median PFS in the short-term maintenance group was 5.1 years (95% CI: 4.4-7.4) and median OS was 9.8 years (95% CI: 8.2- to NR), whereas in the continuous maintenance group both median PFS (95% CI: 8.5- NR) and OS were not reached. This latter group had significantly longer PFS and OS than the short-term maintenance group with a 5-year estimated PFS of 80% (95%CI: 74-85%) vs. 50% (95% CI: 39-60%) (p The most common reasons for early discontinuation of maintenance therapy (< 3 years) were adverse events related to maintenance therapy (58%). Four patient (4%) patients developed second primary malignancy (SPM) in this group. The most frequent hematological adverse events (AEs) were pancytopenia and isolated neutropenia. Fatigue and diarrhea were the most common non-hematological AEs. The reasons for stopping maintenance in the continued maintenance group were disease progression (24%) and adverse events (14%), while five patients (2%) developed SPM. Conclusion: In our institutional experience, 30 percent of MM patients discontinued maintenance therapy within 3 years of ASCT due to AEs or patient preference. These patients had inferior PFS and OS after ASCT compared to patients on continuous maintenance. Therefore, continuation of maintenance therapy should be strongly encouraged as safely possible and strategies like dose reduction or switching therapy are recommended. Figure 1 Figure 1. Disclosures Bumma: Janssen: Membership on an entity's Board of Directors or advisory committees; Amgen: Speakers Bureau; Sanofi: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
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- 2022
14. Outcomes After Salvage Autologous Hematopoietic Cell Transplant for Patients With Relapsed/Refractory Multiple Myeloma: A Single-Institution Experience
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Abdullah M. Khan, Michael Ozga, Harshil Bhatt, Muhammad S. Faisal, Sadia Ansari, Qiuhong Zhao, Naresh Bumma, Francesca Cottini, Srinivas Devarakonda, Ashley Rosko, Nidhi Sharma, Elvira Umyarova, and Don Benson
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Cancer Research ,Oncology ,Hematology - Abstract
The role of salvage autologous hematopoietic cell transplantation (sAHCT2) for patients with relapsed/refractory multiple myeloma (RRMM) in the era of modern therapeutics is unclear. As prospective data is limited, we conducted a retrospective analysis to determine the outcomes of sAHCT2.We conducted a single-institution, retrospective analysis of patients who received sAHCT2 at The Ohio State University from 2000 to 2018. Patients who received a second transplant as part of a planned tandem or autologous-allogeneic transplant were excluded.Fifty-seven patients were treated with sAHCT2. Patients had a median of 2 lines of therapy after AHCT1 prior to their sAHCT2; 70% had prior immunomodulatory imide drugs, 82% had prior proteasome inhibitor, and 20% had prior anti-CD38 monoclonal antibodies as part of re-induction therapy. Forty-two percent of patients attained ≥VGPR prior to sAHCT2. Seventy-four were treated with melphalan 200 mg/mFor MM patients deriving durable remission after their AHCT1, sAHCT2 was safe and resulted in deep and durable remissions.
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- 2022
15. A Multicenter Phase I Dose-Escalation Trial of a Novel Glutaminase Inhibitor Telaglenastat in Combination with Carfilzomib and Dexamethasone in Relapsed and Refractory Multiple Myeloma
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Wilson I. Gonsalves, Natalia Neparidze, Jacob B. Allred, Shaji K Kumar, Joel M. Reid, Geoffrey Shapiro, Brian A. Costello, Richard Piekarz, Rachid C. Baz, and Srinivas Devarakonda
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
16. The Co-Occurrence of 1q21+/1q23+ and t(4;14) Abnormalities with Specific Clone Size Is Predictive of Shorter Response to Transplant in Patients with Multiple Myeloma
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Michael P. Ozga, Qiuhong Zhao, Naresh Bumma, Ashley E. Rosko, Abdullah Khan, Srinivas Devarakonda, Elvira Umyarova, Don M. Benson, and Francesca Cottini
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
17. T-Cell Senescence and Exhaustion Are Associated with Interval Progression of Multiple Myeloma before Autologous Hematopoietic Cell Transplant
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Alicia Bao, Ruchi Kudalkar, Jose Rodriguez, Qiuhong Zhao, Nidhi Sharma, Naresh Bumma, Srinivas Devarakonda, Abdullah Khan, Ashley E. Rosko, Elvira Umyarova, Don M. Benson, and Francesca Cottini
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
18. Comparison of Patient Outcomes With Two Different Formulations of Melphalan as Conditioning Chemotherapy for Autologous Hematopoietic Cell Transplantation in Multiple Myeloma
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Abdullah M. Khan, Filiz Yucebay, Qiuhong Zhao, Elvira Umyarova, Francesca Cottini, Naresh Bumma, Ashley Rosko, Don Benson, Nidhi Sharma, Yvonne Efebera, and Srinivas Devarakonda
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Cancer Research ,Oncology ,Hematology - Abstract
High-dose melphalan (HDM) with autologous hematopoietic cell transplantation (AHCT) after induction chemotherapy is considered standard of care in transplant-eligible patients with newly-diagnosed multiple myeloma (MM). Alkeran melphalan has propylene glycol as a solvent (PG-mel) while Evomela utilizes a propylene glyclol-free formulation (PGF-mel). We evaluated the differences in efficacy and safety of the 2 formulations as there are no prospective head-to-head trials.We retrospectively reviewed the medical records of all 259 consecutive MM patients who received PGF-mel as part of HDM-AHCT at The Ohio State University (OSU). The comparator group was the preceding 255 patients who received PG-mel.Baseline patient characteristics were similar between the 2 groups. Post-AHCT rates of relapse were comparable in the PG-mel and PGF-mel groups. Some adverse events were observed at a higher frequency in the PG-mel group compared to the PGF-mel group (grade ≥ 2 mucositis, febrile neutropenia, other infectious complications, and acute renal insufficiency). Time to neutrophil engraftment was slightly longer in the PG-mel group while time to platelet engraftment was longer in PGF-mel group. Red cell transfusion requirement was higher with the use of PG-mel but not platelet transfusion. Duration of hospitalization was slightly shorter with PGF-mel but readmission rates within 30 days of discharge were higher.Considering possible confounding factors could possibly account for observed differences in some adverse events, the comparable treatment responses, and difference in cost of the 2 formulation, The OSU reverted to PG-mel as the preferred formulation for HDM-AHCT in MM.
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- 2022
19. Impact of Opioid Use after Blood and Marrow Transplantation (BMT): A Single-Center Analysis
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Noha N. Soror, Ayman Saad, Nicole Grieselhuber, Marcin Puto, Alice S. Mims, Naresh Bumma, Abdullah Khan, Yvonne A. Efebera, Bradley W. Blaser, Karilyn Larkin, Basem M. William, Sam Penza, Maria Chaudhry, Srinivas Devarakonda, Sumithira Vasu, Ashleigh Keiter, Samantha Jaglowski, Jonathan E. Brammer, Sarah A Wall, Don M. Benson, Qiuhong Zhao, Patrick Elder, Hannah Choe, and Ashley E. Rosko
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Oncology ,Transplantation ,medicine.medical_specialty ,Marrow transplantation ,business.industry ,Opioid use ,Cell Biology ,Hematology ,Single Center ,Internal medicine ,medicine ,Molecular Medicine ,Immunology and Allergy ,business - Published
- 2021
20. AL amyloidosis: The effect of fluorescent in situ hybridization abnormalities on organ involvement and survival
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Samantha LoRusso, Qiuhong Zhao, Jason Prosek, Katherine Pfund, Srinivas Devarakonda, Ashley E. Rosko, Patrick Elder, Elyse Redder, Ajay Vallakati, Jordan Bittengle, Yvonne A. Efebera, Courtney M. Campbell, Maria Chaudhry, Salem Almaani, Nidhi Sharma, Samir V. Parikh, Naresh Bumma, Don M. Benson, Abdullah Khan, Rami Kahwash, Nita Williams, Miriam Freimer, and Michael Ozga
- Subjects
0301 basic medicine ,Male ,Cancer Research ,Gastroenterology ,Translocation, Genetic ,plasma cell burden ,0302 clinical medicine ,Immunoglobulin Light-chain Amyloidosis ,Multiple myeloma ,In Situ Hybridization, Fluorescence ,Original Research ,Aged, 80 and over ,education.field_of_study ,Amyloidosis ,Middle Aged ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prognosis ,Combined Modality Therapy ,Survival Rate ,myeloma ,Oncology ,030220 oncology & carcinogenesis ,Female ,Hyperdiploidy ,Adult ,medicine.medical_specialty ,Population ,lcsh:RC254-282 ,survival ,03 medical and health sciences ,Internal medicine ,medicine ,AL amyloidosis ,Humans ,Radiology, Nuclear Medicine and imaging ,Progression-free survival ,education ,Aged ,Retrospective Studies ,amyloidosis ,Chromosome Aberrations ,light‐chain amyloidosis ,business.industry ,Cytogenetics ,Clinical Cancer Research ,Retrospective cohort study ,medicine.disease ,Aneuploidy ,030104 developmental biology ,fluorescent in situ hybridization ,business ,Follow-Up Studies - Abstract
Background Systemic light chain (AL) amyloidosis is a clonal plasma‐cell neoplasm that carries a poor prognosis. Although AL amyloidosis and Multiple Myeloma (MM) can co‐exist and share various cytogenetic chromosomal abnormalities, little is known about Fluorescent in situ hybridization (FISH) and its prognostic relevance in AL amyloidosis. Aim: The study aims to evaluate the most prevalent FISH cytogenetic abnormalities in AL patients as independent prognostic factors, and assess the impact of cytogenetics on the survival of high‐risk cardiac AL patients. Materials & Methods This retrospective study reviewed 113 consecutive AL patients treated at The Ohio State University (OSU). Patients were divided into subgroups based on FISH data obtained within 90 days of diagnosis. Hyperdiploidy was defined as trisomies of at least 2 chromosomal loci. Primary endpoints were progression free survival (PFS) and overall survival (OS). Kaplan Meier curves were used to calculate PFS and OS. The log‐rank test and Cox proportional hazard models were used to test the equality of survival functions and further evaluate the differences between groups. Results FISH abnormalities were detected in 76% of patients. Patients with abnormal FISH trended toward lower overall survival (OS) (p=0.06) and progression free survival (PFS) (p=0.06). The two most prevalent aberrations were translocation t(11;14) (39%) and hyperdiploidy‐overall (38%). Hyperdiploidy‐overall was associated with worsening PFS (p=0.018) and OS (p=0.03), confirmed in multivariable analysis. Patients with del 13q most frequently had cardiac involvement (p=0.006) and was associated with increased bone marrow plasmacytosis (p=0.02). Cardiac AL patients with no FISH abnormalities had much improved OS (p=0.012) and PFS (p=0.018) Conclusions Our findings ultimately reveal the association of hyperdiploidy on survival in AL amyloidosis patients, including the high‐risk cardiac AL population., Hyperdiploidy in AL amyloidosis patients was associated with poor PFS and OS and cardiac AL patients had a strong association with del 13q.
- Published
- 2020
21. Diffuse 'background' monoclonal light chain staining on kidney biopsies in the absence of electron-dense deposits – putting it into perspective: A retrospective cohort study
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Anjali A. Satoskar, Sergey V. Brodsky, Ahlim Alsanani, Isabelle Ayoub, Abdullah Khan, Srinivas Devarakonda, Clarissa A. Cassol, Kiran Kandukurti, Jason Prosek, and Tibor Nadasdy
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Kidney ,Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Paraproteinemias ,Retrospective cohort study ,General Medicine ,medicine.disease ,Immunoglobulin light chain ,Immunofluorescence ,Staining ,medicine.anatomical_structure ,Nephrology ,Monoclonal ,Biopsy ,medicine ,Humans ,Kidney Diseases ,business ,Retrospective Studies ,Kidney disease - Abstract
Background Pathologic diagnosis of monoclonal gammopathy (MIg)-associated kidney disease requires specific morphologic and immunofluorescence (IF) findings with deposits on electron microscopy. We have encountered kidney biopsies showing only diffuse "background" monoclonal light chain staining, without characteristic morphologic or ultrastructural findings. Such staining is often overlooked if weak, or over-diagnosed as MIg-associated kidney disease if strong, causing dilemma over the need for immediate clone-directed therapy. We performed a clinicopathologic study to better understand its significance. Materials and methods Database search revealed 32 such cases over 12 years. Demographic, laboratory, and pathology data were retrieved along with a mean follow-up of 13 months. Results 15/32 (47%) patients did have active myeloma on hematologic testing (without myeloma casts) warranting immediate clone-directed therapy; but 11/32 (34%) did not develop active myeloma; 3/32 (9%) did not even have detectable paraprotein; 3/32 (9%) were lost to follow-up. Importantly, strong background light chain staining was seen even in some non-myeloma biopsies and conversely, weak staining was seen in some myeloma biopsies, complicating diagnosis. Conclusion It is important to recognize and document this finding in the biopsy report, but by itself, it should not be classified as MIg-associated kidney disease even in the face of strong staining intensity. A thorough hematologic work-up is critically important to unmask underlying active myeloma, which many patients may have. But equally important is to avoid inadvertent clone-directed therapy in patients who do not have active myeloma despite the background monoclonal staining. A protocol for periodic monitoring with hematologic and renal parameters to watch for possible malignant transformation is recommend for timely implementation of therapy to minimize renal damage.
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- 2020
22. P-250: Predictive factors for outcomes after salvage autologous hematopoietic cell transplant for patients with relapsed/refractory multiple myeloma: a single-institution experience
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Abdullah Khan, Muhammad Faisal, Qiuhong Zhao, Michael Ozga, Naresh Bumma, Francesca Cottini, Srinivas Devarakonda, Ashley Rosko, Elvira Umyarova, and Don Benson
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Cancer Research ,Oncology ,Hematology - Published
- 2022
23. Nodular pulmonary deposition disease in a patient with the acquired immunodeficiency syndrome: a case report
- Author
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I-Sanna Gibbons-Fideler, Konstantin Shilo, Mark E. Lustberg, Srinivas Devarakonda, and Jessica N. Mezzanotte
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Lung Diseases ,Pathology ,medicine.medical_specialty ,lcsh:Medicine ,Case Report ,Light chain deposition disease ,Light chain deposition disease (LCDD) ,03 medical and health sciences ,0302 clinical medicine ,Hypergammaglobulinemia ,Eosinophilic ,Biopsy ,Medicine ,Humans ,Lung ,Acquired Immunodeficiency Syndrome ,medicine.diagnostic_test ,business.industry ,lcsh:R ,HIV ,General Medicine ,Middle Aged ,medicine.disease ,AIDS ,medicine.anatomical_structure ,030228 respiratory system ,030220 oncology & carcinogenesis ,Serum protein electrophoresis ,Positron-Emission Tomography ,Female ,Immunoglobulin Light Chains ,Differential diagnosis ,business ,Tomography, X-Ray Computed ,Monoclonal gammopathy of undetermined significance - Abstract
Background Pulmonary nodules are a common cause for concern in patients with human immunodeficiency virus and acquired immunodeficiency syndrome. Most commonly, they are the result of an infection, given the patients’ immunocompromised state; however, in some cases, pulmonary nodules in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome can result from cellular or protein deposits. We report a rare case of nodular pulmonary light chain deposition disease in a patient with acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance. Case presentation A 53-year-old African American woman with acquired immunodeficiency syndrome had pulmonary nodules detected incidentally by imaging of her lungs. Pulmonary tuberculosis was high on the differential diagnosis, but she had a negative test result for pulmonary tuberculosis. Imaging also revealed multiple lucent bone lesions, and earlier in the year, serum protein electrophoresis had shown an immunoglobulin G-kappa monoclonal protein (M spike). She was mildly anemic, so there was concern for progression to myeloma; however, the result of her bone marrow biopsy was unremarkable. Lung biopsy revealed finely granular eosinophilic material with negative Congo red staining, consistent with light chain deposition disease. Conclusions The extent of this patient’s light chain deposition disease was thought to be caused by a combination of acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance, and the interval decrease in lung nodule size after restarting antiretroviral therapy confirms this hypothesis and also highlights a potentially unique contribution of the hypergammaglobulinemia to this disease process in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome .
- Published
- 2020
24. Lenalidomide and Vorinostat Maintenance after Autologous Transplantation in Multiple Myeloma: Long- Term Follow-Up
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Douglas W. Sborov, Yvonne A. Efebera, Qiuhong Zhao, Craig C. Hofmeister, Don M. Benson, Srinivas Devarakonda, Nidhi Sharma, David Chen, Naresh Bumma, Abdullah Khan, Maria Chaudhry, Nita Williams, and Ashley E. Rosko
- Subjects
Adult ,Male ,Oncology ,medicine.medical_specialty ,medicine.drug_class ,Disease-Free Survival ,Maintenance Chemotherapy ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Maintenance therapy ,law ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Medicine ,Autologous transplantation ,Autografts ,Lenalidomide ,Vorinostat ,Multiple myeloma ,Aged ,Transplantation ,business.industry ,Histone deacetylase inhibitor ,Hematopoietic Stem Cell Transplantation ,Hematology ,Middle Aged ,medicine.disease ,Survival Rate ,030220 oncology & carcinogenesis ,Female ,Multiple Myeloma ,business ,030215 immunology ,medicine.drug - Abstract
Post-autologous stem cell transplantation (ASCT) maintenance therapy with lenalidomide is standard of care for patients with multiple myeloma (MM). Effective and tolerable drug combinations may further enhance the clinical response post-ASCT. Vorinostat, a histone deacetylase inhibitor, induces antiproliferative and proapoptotic effects in patients with MM. We hypothesized that combination maintenance therapy would further prolong the clinical response achieved from transplantation. We previously reported that the combination of lenalidomide and vorinostat as maintenance post-ASCT was tolerable in 16 patients with MM. We now present the long-term follow up of these patients. Progression-free survival (PFS) and overall survival (OS) outcomes were characterized using the Kaplan-Meier method. Five patients (31%) had high-risk disease, and the median number of lines of therapy before ASCT was 1 (range, 1 to 5). With a median follow-up of 89.8 months from ASCT, the median PFS was 64.3 months (range, 21.7 months to not reached [NR]), and OS was not reached (median, 53.0 months to NR). At the time of this report, 5 patients remained on the study. The combination of vorinostat and lenalidomide as maintenance post-ASCT is tolerable and induces a durable response. A phase III randomized study of lenalidomide versus a combination with vorinostat is warranted.
- Published
- 2020
25. Impact of Race and Geographic Area of Residence on Outcomes After Allogeneic Stem Cell Transplant
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Audrey M. Sigmund, Qiuhong Zhao, Justin Jiang, Patrick Elder, Don M. Benson, Ashley Rosko, Naresh Bumma, Abdullah Khan, Srinivas Devarakonda, Sumithira Vasu, Samantha Jaglowski, Alice Mims, Hannah Choe, Karilyn Larkin, Jonathan Brammer, Sarah Wall, Nicole Grieselhuber, Ayman Saad, Sam Penza, Yvonne A. Efebera, and Nidhi Sharma
- Subjects
Cancer Research ,Oncology - Abstract
BackgroundAllogeneic hematopoietic stem cell transplant (allo-HCT) is a potential curative therapy for a variety of hematologic disorders. However, it requires highly specialized care that is only available at select centers across the country. Thus, minority populations are at risk for healthcare disparities in access to and outcomes of allo-HCT. Our study aimed to assess the impact of race and location of residence on outcomes of allo-HCT.MethodsWe performed a retrospective analysis of all patients who underwent allo-HCT at the Ohio State University from 1984 to 2018. Patients were divided by race (Caucasian, African American, and other) and grouped by zip code into rural, suburban, and urban groups. Primary endpoints included progression-free survival (PFS) and overall survival (OS).ResultsOf the 1,943 patients included in the study, 94.3% self-identified as Caucasian, 4.6% African American, and 1.1% other. In total, 63.4% lived in rural areas, 22.9% suburban, and 13.8% urban. There was no significant difference in OS or PFS by race (p = 0.15, 0.21) or place of residence (p = 0.39, 0.17). In addition, no difference in nonrelapse mortality, acute and chronic graft-versus-host disease (GVHD), and GVHD-free relapse-free survival (GRFS) was seen among the race or place of residence.ConclusionOur study suggests that when appropriate access to HCT is given, there is no difference in outcomes based on race, ethnicity or place of primary residence. Further research is needed to further evaluate barriers for these patients to undergo transplant and help mitigate these barriers.
- Published
- 2021
26. Allogenic Transplantation in Older Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome
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Audrey M. Sigmund, Justin Jiang, Qiuhong Zhao, Patrick Elder, Ashley Rosko, Naresh Bumma, Abdullah Khan, Srinivas Devarakonda, Sumithira Vasu, Samantha Jaglowski, Alice Mims, Hannah Choe, Karilyn Larkin, Jonathan E. Brammer, Sarah A. Wall, Nicole Grieselhuber, Ayman Saad, Sam Penza, Marcos De Lima, Don M Benson, Yvonne Efebera, and Nidhi Sharma
- Subjects
Transplantation ,Molecular Medicine ,Immunology and Allergy ,Cell Biology ,Hematology - Published
- 2022
27. Outcomes of Bone Marrow Compared to Peripheral Blood for Haploidentical Transplantation
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Karilyn Larkin, Audrey M. Sigmund, Alice S. Mims, Patrick Elder, Nicole Grieselhuber, Ayman Saad, Yvonne A. Efebera, Qiuhong Zhao, Srinivas Devarakonda, Sarah A Wall, Ashley E. Rosko, Don M. Benson, Muhammad Salman Faisal, Justin Jiang, Sumithira Vasu, Hannah Choe, Nidhi Sharma, Naresh Bumma, Abdullah Khan, Jonathan E. Brammer, Sam Penza, Samantha Jaglowski, and Maria Chaudhry
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medicine.medical_specialty ,bone marrow ,Cyclophosphamide ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,haploidentical transplantation ,business.industry ,Incidence (epidemiology) ,allogenic transplantation ,General Medicine ,peripheral blood ,Confidence interval ,Peripheral blood ,Transplantation ,medicine.anatomical_structure ,surgical procedures, operative ,030220 oncology & carcinogenesis ,Cohort ,Medicine ,Bone marrow ,Stem cell ,business ,030215 immunology ,medicine.drug - Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) from a haploidentical (haplo) donor has emerged as a suitable alternative in the absence of a matched donor. However, haplo-HCT patients have a higher risk of graft-versus-host disease (GVHD). Hence, bone marrow (BM) stem cell source and post-transplant cyclophosphamide (PTCy) have been routinely used to help mitigate this. Due to ease of collection, peripheral blood (PB) stem cells are increasingly being considered for haplo-HCT. We retrospectively analyzed 74 patients (42 BM and 32 PB) who underwent haplo-HCT at Ohio State University from 2009 to 2018. Median age at transplant was 60 years (yrs) for BM and 54 yrs for PB, (p = 0.45). There was no difference in OS (p = 0.13) and NRM (p = 0.75) as well as PFS (p = 0.10) or GRFS (p = 0.90) between the groups. The BM cohort showed a 3-year OS rate of 63% (95% confidence interval (CI): 46–76), and 3-year PFS of 49% (95% CI: 33–63). For the PB group, 3-year OS and PFS were 78% (95% CI: 59–89) and 68% (95% CI: 49–82), respectively. There were no differences in the incidence of acute GVHD (grade II-IV) (p = 0.31) and chronic GVHD (p = 0.18). Patients receiving BM had a significantly higher risk for relapse with relapse rates by 2 years at 36% (95% CI: 22–50) vs. 16% (95% CI: 6–31) for PB (p = 0.03). The findings from this study suggest that PB is an excellent alternative to BM for haplo-HCT.
- Published
- 2021
28. Improvement in Post-Autologous Stem Cell Transplant Survival of Multiple Myeloma Patients: A Long-Term Institutional Experience
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Jordan Nunnelee, Francesca Cottini, Qiuhong Zhao, Muhammad Salman Faisal, Patrick Elder, Ashley Rosko, Naresh Bumma, Abdullah Khan, Srinivas Devarakonda, Don M. Benson, Yvonne Efebera, and Nidhi Sharma
- Subjects
multiple myeloma ,novel agents ,older ,FISH ,ASCT ,Cancer Research ,Oncology - Abstract
Multiple myeloma (MM) represents 1.8% of all new cancer cases in the U.S. While not curable, advances in treatment, including autologous stem cell transplant (ASCT) and maintenance therapy, have dramatically improved progression-free survival (PFS) and overall survival (OS). We performed a retrospective survival analysis on newly diagnosed MM (NDMM) patients receiving ASCT from 1992–2016 at the Ohio State University. A total of 1001 consecutive NDMM patients were eligible. Patients were split into five groups based on historic changes in novel agents for the treatment of MM. Across the years (1992–2016), there was a statistically significant improvement in both PFS (p < 0.01) and OS (p < 0.01). Significant improvements in both PFS and OS were seen in patients ≤65 years (p < 0.001 and p = 0.002) and >65 years old (p < 0.001 and p = 0.001), respectively. Improved PFS and OS were seen in both standard-risk (p < 0.001 and p < 0.001) and high-risk patients (p < 0.001 and p = 0.019). The post-transplant response showed statistically significant improvement across the years (p < 0.01). Survival rates for NDMM patients have significantly improved primarily due to the inclusion of novel therapies and post-ASCT maintenance.
- Published
- 2022
29. Effect of Early Post-Transplantation Tacrolimus Concentration on the Risk of Acute Graft-Versus-Host Disease in Allogenic Stem Cell Transplantation
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Don M. Benson, Jonathan E. Brammer, Nicole Grieselhuber, Karilyn Larkin, Nidhi Sharma, Naresh Bumma, Qiuhong Zhao, Abdullah Khan, Patrick Elder, Samantha Jaglowski, Alice S. Mims, Bin Ni, Hannah Choe, Yvonne A. Efebera, Srinivas Devarakonda, Sam Penza, Maria Chaudhry, Basem M. William, Ayman Saad, Marcin Puto, Ashley E. Rosko, Sumithira Vasu, and Sarah A Wall
- Subjects
Cancer Research ,medicine.medical_specialty ,chemical and pharmacologic phenomena ,Lower risk ,Gastroenterology ,lcsh:RC254-282 ,Article ,03 medical and health sciences ,0302 clinical medicine ,immune system diseases ,allogeneic stem cell transplantation ,Internal medicine ,hemic and lymphatic diseases ,graft versus host disease ,medicine ,Cumulative incidence ,tacrolimus ,relapse ,business.industry ,Myeloid leukemia ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Tacrolimus ,Calcineurin ,Transplantation ,stomatognathic diseases ,Graft-versus-host disease ,surgical procedures, operative ,Oncology ,Quartile ,030220 oncology & carcinogenesis ,business ,030215 immunology - Abstract
Acute graft versus host disease (aGVHD) remains a leading cause of morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HSCT). Tacrolimus (TAC), a calcineurin inhibitor that prevents T-cell activation, is commonly used as a GVHD prophylaxis. However, there is variability in the serum concentrations of TAC, and little is known on the impact of early TAC levels on aGVHD. We retrospectively analyzed 673 consecutive patients undergoing allo-HSCT at the Ohio State University between 2002 and 2016. Week 1 TAC was associated with a lower risk of aGVHD II–IV at TAC level ≥ 10.15 ng/mL (p = 0.03) compared to the lowest quartile. The cumulative incidence of relapse at 1, 3 and 5 years was 33%, 38% and 41%, respectively. TAC levels at week 2, ≥ 11.55 ng/mL, were associated with an increased risk of relapse (p = 0.01) compared to the lowest quartile. Subset analysis with acute myeloid leukemia and myelodysplastic syndrome patients showed significantly reduced aGVHD with TAC level ≥ 10.15 ng/mL at week 1 and a higher risk of relapse associated with week 2 TAC level ≥11.55 ng/mL (p = 0.02). Hence, achieving ≥10 ng/mL during the first week of HCT may mitigate the risk of aGVHD. However, levels (>, 11 ng/mL) beyond the first week may be associated with suppressed graft versus tumor effect and higher relapse.
- Published
- 2021
30. Role of Stem Cell Transplantation in Multiple Myeloma
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Nidhi Sharma, Yvonne A. Efebera, and Srinivas Devarakonda
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Oncology ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Review ,autologous ,lcsh:RC254-282 ,stem cell transplantation ,maintenance ,03 medical and health sciences ,0302 clinical medicine ,Autologous stem-cell transplantation ,Maintenance therapy ,immune system diseases ,Internal medicine ,hemic and lymphatic diseases ,allogenic ,medicine ,Multiple myeloma ,Chemotherapy ,business.industry ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Clinical trial ,Transplantation ,multiple myeloma ,medicine.anatomical_structure ,surgical procedures, operative ,030220 oncology & carcinogenesis ,Bone marrow ,Stem cell ,business ,030215 immunology - Abstract
Simple Summary The aim of this review is to provide an overview of the current scientific evidence concerning the role of stem cell transplantation in multiple myeloma. During the past decade, several new treatment options have become available, thereby questioning the role of stem cell transplantation for the management of multiple myeloma. This review focuses on these studies, demonstrating a benefit for autologous stem cell transplantation (auto-SCT). We also reviewed maintenance post auto-SCT and utility of allogeneic stem cell transplant. Abstract Autologous stem cell transplantation (auto-SCT) has been the standard of care in eligible newly diagnosed multiple myeloma (MM) patients. Outcomes of patients with MM have improved significantly due to the advent of several novel drugs. Upfront use of these drugs in induction therapy has significantly increased the rate and depth of responses that have translated into longer remission and survival. This has now raised a debate regarding the role and relevance of auto-SCT in the management of myeloma. However, clinical trials have confirmed the utility of auto-SCT even in the era of novel drugs. Tandem auto-SCT followed by maintenance has shown a progression-free survival (PFS) benefit in high-risk MM, and hence can be considered in young and fit patients with high-risk disease. Auto-SCT has the advantages of resetting the bone marrow microenvironment, short-lived toxicity compared to the long-term physical and financial toxicities of continued chemotherapy in the absence of SCT, very low transplant-related mortality (TRM) in high volume centers, and providing longer disease-free survival when followed by maintenance therapy. Allogeneic SCT is one potentially curative option for MM, albeit with an increased risk of death due to high TRM. Strategies to modulate the graft-versus-host disease (GVHD) while maintaining or improving the graft-versus-myeloma (GVM) effect could place allogeneic SCT back in the treatment armamentarium of MM.
- Published
- 2021
31. Minimal residual disease in multiple myeloma: are we there yet?
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Srinivas Devarakonda and Yogesh Jethava
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Oncology ,medicine.medical_specialty ,bone marrow ,business.industry ,imaging ,Hematology ,medicine.disease ,Minimal residual disease ,survival ,cure ,complete response ,multiple myeloma ,medicine.anatomical_structure ,MRD ,Internal medicine ,medicine ,Commentary ,minimal residual disease ,Pharmacology (medical) ,next-generation sequencing ,Bone marrow ,business ,Multiple myeloma ,Complete response - Published
- 2020
32. InsideOut: Model to Predict Outside CO Concentrations from Mobile CO Dosimeter Measurements Inside Vehicles
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Daehan Kwak, Srinivas Devarakonda, Badri Nath, and Senthil Chittaranjan
- Subjects
Pollution ,Dosimeter ,Artificial neural network ,business.industry ,Computer science ,media_common.quotation_subject ,Real-time computing ,Neural network architecture ,Internet of Things ,business ,Moving vehicle ,Mobile device ,media_common - Abstract
The current pollution measurement methodology is coarse-grained where the pollution measurements are spatiotemporally few and far in-between. Our vision is to provide broadly accessible, fine-grained pollution information to a variety of end-users, and in turn, allow them to make better informed decisions using a new, more accurate information stream. To this end, this study proposes a new neural network model to estimate Carbon Monoxide (CO) concentrations outside vehicle from crowd-sourced CO measurements inside vehicles measured using mobile devices (dosimeters). End-users can benefit from the fine-grained pollution information generated by this prediction model along with data from direct measurements. A neural network is used to model the dynamic relationship between the CO measurements inside and outside a moving vehicle. The resulting neural network model is then used to predict outside CO concentrations from CO measurements inside vehicles. Mobile CO dosimeters were used inside and outside vehicles to collect measurements used in training a neural network based regression model. For this regression task, a new neural network architecture was designed using Convolutional layers and Gated Recurrent Unit (GRU) layers. The results show that outside CO concentrations can be estimated from inside vehicle CO measurements with high accuracy. The proposed neural network model provides a promising new and novel source of fine-grained pollution information along with direct measurement streams.
- Published
- 2020
33. Real World Experience of Daratumumab: Evaluating Lymphopenia and Adverse Events in Multiple Myeloma Patients
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Maria Chaudhry, Yvonne A. Efebera, Ying Huang, Ashley E. Rosko, Nita Williams, Don M. Benson, Naresh Bumma, Abdullah Khan, Francesca Cottini, and Srinivas Devarakonda
- Subjects
medicine.medical_specialty ,Cancer Research ,medicine.drug_class ,Disease ,CD38 ,Monoclonal antibody ,outcomes ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,immune system diseases ,Internal medicine ,hemic and lymphatic diseases ,medicine ,Clinical significance ,infections ,Adverse effect ,Multiple myeloma ,Original Research ,business.industry ,Daratumumab ,Cancer ,lymphopenia ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,daratumumab ,myeloma ,Oncology ,030220 oncology & carcinogenesis ,business ,030215 immunology - Abstract
Multiple myeloma (MM) is an incurable disease with a limited life expectancy of five years from diagnosis. Uncontrolled disease or infections are the main causes of mortality. Daratumumab, a monoclonal antibody against CD38, is approved to treat patients with MM. Its target, CD38, is expressed not only on MM cells but also on common lymphoid precursors and subsets of normal lymphocytes. Daratumumab-induced lymphopenia is common, but its clinical significance is understudied. In this study, we report the baseline characteristics, rates of severe lymphopenia, infections, and clinical trajectory of multiple myeloma patients (n = 100) treated with daratumumab-based regimens at the Ohio State University Comprehensive Cancer Center. We discover high rates of infections, hospital utilization, and severe lymphopenia and identify risks factors for severe lymphopenia, such as low pretreatment absolute lymphocyte count (ALC) values. Severe lymphopenia persists in 23% of patients, resulting in worst survival outcomes. Our data underline the importance of monitoring ALC and consider future use of prophylactic measures or alternative regimens in subsets of MM patients.
- Published
- 2020
34. Heavy Lifting: Nomenclature and Novel Therapy for Gamma Heavy Chain Disease and Other Heavy Chain Disorders
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Srinivas Devarakonda, Yvonne A. Efebera, Naresh Bumma, Abdullah Khan, Sara Singer, Don M. Benson, Ashley E. Rosko, and Maria Chaudhry
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Bendamustine ,Male ,Cancer Research ,medicine.medical_treatment ,Hematopoietic stem cell transplantation ,030204 cardiovascular system & hematology ,Immunoglobulin light chain ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Gamma Heavy Chain Disease ,business.industry ,Bortezomib ,Hematology ,Middle Aged ,medicine.disease ,Heavy chain disease ,Oncology ,030220 oncology & carcinogenesis ,Cancer research ,Immunoglobulin heavy chain ,Rituximab ,Female ,business ,medicine.drug ,Heavy Chain Disease - Abstract
Heavy chain disorders are rare B-cell disorders and include heavy chain disease, heavy chain deposition disease, and heavy chain amyloidosis. These disorders share the pathognomonic finding of a truncated immunoglobulin heavy chain without an associated light chain in the serum or urine in the case of heavy chain disease or in the tissues in the case of heavy chain deposition disease and heavy chain amyloidosis but are clinically distinct entities. The clinical recognition and systematic approaches to these disorders are challenging because of the rarity of the diseases, lack of consensus on treatment approaches, and minimal data with novel therapy. Herein we present a review of the literature and 5 consecutive cases at a single institution of gamma heavy chain disease and heavy chain deposition disease treated with novel agents including regimens of CRd (cyclophosphamide, lenalidomide, and dexamethasone), CyBorD (cyclophosphamide, bortezomib, and dexamethasone), R-CVP (rituximab, cyclophosphamide, vincristine, and dexamethasone), BR (bendamustine and rituximab), V-EPOCH (bortezomib, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin), and autologous hematopoietic stem cell transplantation.
- Published
- 2019
35. Atypical metastasis of renal cell carcinoma to the uvula: case report and review of literature
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Parth Khade and Srinivas Devarakonda
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Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Case Report ,urologic and male genital diseases ,Malignancy ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Vascularity ,vascular ,Renal cell carcinoma ,Biopsy ,cancer ,metastasis ,Medicine ,palate ,medicine.diagnostic_test ,business.industry ,kidney cancer ,Cancer ,030206 dentistry ,General Medicine ,medicine.disease ,Nephrectomy ,medicine.symptom ,soft tissue ,business ,Kidney cancer - Abstract
Renal cell carcinoma (RCC) is a common malignancy with high metastatic potential, primarily due to its extensive vascularity. Common sites of metastasis include lungs, bone, lymph nodes, liver, and brain. However, rare cases of metastasis to other sites including inguinal lymph nodes, peritoneum/mesentery, and orbit have been published in the literature. Herein, a unique case involving metastasis of RCC to the uvula is presented. The patient is a 55-year-old White female with a past medical history of stage 3 (T3aN0M0) RCC s/p nephrectomy 3 years prior to presentation. She had symptoms of a foreign body sensation at the back of her throat, and oropharyngeal examination revealed uvular erythematous mass with vascularity. Uvular biopsy and complete excision were performed, which revealed metastatic RCC. Palate biopsy was negative and revealed only squamous mucosa with mild chronic inflammation. To our knowledge, there is only one other documented case of RCC metastasis to the uvula in the literature.
- Published
- 2018
36. Multidisciplinary Provider Insights to Promote Adoption of Bispecific Antibodies to Treat Cancer in the Community
- Author
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Limaya Atembina, Leigh Boehmer, Kelly Terrell, Rima Koka, Murali Janakiram, Axel Grothey, Amy L Morris, Srinivas Devarakonda, Barbara Rogers, Ronan Kelly, Jesus Berdeja, and Firas El Chaer
- Subjects
Immunology ,Cell Biology ,Hematology ,Biochemistry - Abstract
Bispecific antibodies (BsAbs) are an emerging class of novel immunotherapy agents that have led to major breakthroughs in the treatment of hematologic malignancies. By targeting two separate antigens at the same time, BsAbs can bridge tumor cells to cytotoxic immune cells and bypass several limitations of conventional monoclonal antibody treatment (Wang et al., 2019). In 2020, the Association of Community Cancer Centers (ACCC) launched an ongoing education program to identify and address barriers to awareness, preparedness, adoption, and use of BsAbs to treat cancer. As part of this program, ACCC developed a survey with an expert Advisory Committee to gain an understanding of multidisciplinary cancer providers' experiences with BsAbs. The survey primarily assessed experiences with blinatumomab, the first FDA-approved bispecific antibody for the treatment of malignancy (Newman & Benani, 2016). One hundred and twenty-nine individuals responded to the survey. Sixty percent of these respondents reported prescribing, dispensing, and administering blinatumomab and/or caring for patients being treated with blinatumomab. Of those respondents, 44% were medical oncologists/hematologists, 8% were advanced practice providers (APPs), 17% were nurses, 23% were pharmacists, and 9% fell into an 'Other' category of various other disciplines. Interestingly, the provider experience with blinatumomab varied greatly. Ninety-two percent of oncologists indicated having experience with blinatumomab while only 35% of nurses reported so. Regarding how blinatumomab is used in the community, respondents indicated that 59% of their institutions use it to treat relapsed or refractory acute lymphoblastic leukemia (ALL) while 41% use it to treat ALL with MRD positivity. Additionally, 74% of oncologists use blinatumomab before CAR-T therapy when considering both therapies for patients with ALL. Survey results also showed that although 79% of providers felt comfortable caring for patients being treated with blinatumomab, 59% identified barriers when caring for these patients. Some of the common challenges include transitioning patients from the inpatient to outpatient setting (41%), managing patients in remote areas (33%), securing insurance coverage (28%), managing side effects (27%), assisting patients with costs (24%), and lacking in-house expertise with the drug (22%). Another reported obstacle was the management neurotoxicity and cytokine release syndrome (CRS). In the survey, less than half of oncologists reported experience with managing neurotoxicity or CRS and only 6-9% of APPs reported the same. In general, more oncologists described feeling comfortable with using blinatumomab compared to APPs or nurses. Notably, 23% of nurses did not feel they had all the information needed to safely administer blinatumomab. In terms of opportunities to promote smooth adoption of blinatumomab, 86% of respondents indicated that written guidelines, best practices, and care recommendations would be helpful when caring for patients. Specific desired resources include a list of home health pharmacies and agencies familiar with the drug, care coordinators or navigators, best practices on transitioning from inpatient to outpatient administration, information on how to address problems that may occur with outpatient administration, and in-house or onsite expertise from either the drug manufacturer or someone within the organization. Respondents noted direct patient education as another significant area of need. Eighty-two percent felt that educational resources for patients and caregivers on transitioning from inpatient to outpatient care would be beneficial, and 70% thought that peer support services for patients would also be helpful. Multiple BsAbs are in various stages of development for hematologic malignancies. Using blinatumomab as an example, this survey highlighted challenges to the use of BsAbs and identified opportunities to overcome these obstacles. Translation of best practices for use in the community must be established to reach all eligible patients with cancer who may benefit from these therapies. With this survey data, ACCC is positioned to offer this support. Through its education program, ACCC will build on the survey results to develop content and resources that prepare multidisciplinary providers to welcome BsAbs into the community to treat cancer. Disclosures Atembina: Amgen: Research Funding. Boehmer: Pfizer, Inc: Other: paid consultant within the past 12 months; Amgen: Research Funding. Terrell: Amgen: Honoraria. Koka: Amgen: Honoraria. Janakiram: Amgen: Honoraria. Grothey: Amgen: Honoraria. Morris: Amgen: Honoraria. Rogers: Coherus BioSciences: Speakers Bureau; Astra Zeneca: Speakers Bureau. Kelly: Amgen: Honoraria. Berdeja: Poseida: Research Funding; Acetylon: Research Funding; Lilly: Research Funding; Kite Pharma: Consultancy; Genentech: Research Funding; CRISPR Therapeutics: Consultancy, Research Funding; Celularity: Research Funding; Celgene: Consultancy, Research Funding; Teva: Research Funding; EMD Serono: Research Funding; GlaxoSmithKline: Research Funding; SecuraBio: Consultancy; Legend Biotech: Consultancy; Janssen: Consultancy, Research Funding; Novartis: Research Funding; Incyte: Research Funding; Ichnos Sciences: Research Funding; Abbvie: Research Funding; Amgen: Research Funding; Astex Pharmaceuticals: Research Funding; Bluebird bio: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Takeda: Consultancy; Sanofi: Research Funding. El Chaer: Amgen: Honoraria, Research Funding.
- Published
- 2021
37. Survival Analysis of Patients with T-Cell Lymphoma or T-Cell Large Granular Leukemia and Concomitant Plasma Cell Dyscrasias
- Author
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Zachary Braunstein, Maria Chaudhry, Anjali Mishra, Miguel Ruiz, Francesca Cottini, Naresh Bumma, Abdullah Khan, Jonathan E. Brammer, Eric McLaughlin, Pierluigi Porcu, Don M. Benson, Srinivas Devarakonda, Ashley E. Rosko, and John C. Reneau
- Subjects
business.industry ,T cell ,Immunology ,Cell Biology ,Hematology ,Plasma cell ,medicine.disease ,Biochemistry ,Dyscrasia ,Leukemia ,medicine.anatomical_structure ,Concomitant ,medicine ,Cancer research ,T-cell lymphoma ,business ,Survival analysis - Abstract
Introduction: Sporadic cases of patients with a combined T-cell malignancy and plasma cell dyscrasia (PCD) have been reported in the literature. While the most commonly observed association is with T-cell large granular lymphocytic leukemia (T-LGLL) and PCD, there are case reports of other T-cell malignancies and PCD, such as peripheral T-cell lymphoma (PTCL) and angioimmunoblastic T-cell lymphoma (AITL) with multiple myeloma (MM). Nearly one-third of MM patients develop clonal T-cell populations that share a similar immunophenotype to T-LGLL, suggesting likely under diagnosis of concomitant T-cell malignancies in patients with PCD. However, with the limited data available regarding the overlap between PCD and T-cell malignancy, the significance, associated pathogenesis, and impact on survival outcomes is unknown. The purpose of this study is to describe the outcomes of patients with overlapping T-cell malignancies and PCD in order to determine the survival outcomes and ultimately make management/diagnostic recommendations. Methods: In this IRB approved study, we retrospectively evaluated patients with concomitant T-cell malignancy and PCD at Ohio State University from 2010-2020. Patients were identified using a database search for T-cell malignancies as well as PCD. All patients that were included met the 2016 World Health Organization diagnostic criteria for their respective T-cell malignancy and PCD. Progression-free survival (PFS) was measured as time from the start of treatment until first progression, death, or last follow-up according to the Kaplan-Meier method with median survival times and 95% confidence intervals reported. Results: A total of 21 patients, with a median follow-up time of 22 months (range 1-153), were included in this analysis. Baseline demographics are in table 1. The most common T-cell malignancy was T-LGLL (11/21; 52%) and the most common PCD were MGUS (8/21; 38%) and MM (8/21; 38%). Ten (48%) patients presented with a T-cell malignancy as their primary malignancy, 9 (43%) presented with a PCD as their primary malignancy, 1 (5%) patient was diagnosed with both at the same time, and for 1 (5%) patient it is unknown. Within the cohort, 62% (13/21) of patients received primary treatment for their T-cell malignancy and 38% (8/21) of patients received primary treatment for their PCD. Of the 7 patients that had their PCD clone 4 were treated concomitantly and 3 were treated for only their T-cell malignancy. Overall, 9/21 (42.9%) of patients had progression of their T-cell malignancy. A summary of outcomes is provided in Table 2. 54.6% of patients with T-LGLL and 60% of patients with AITL/PTCL experienced progressive T-cell disease and no patients with CTCL had progressive T-cell disease. The median overall survival (OS) across all patients was 4.1 years. Median OS was not reached for patients with T-LGLL, 1.7 years for AITL/PTCL, and 12.4 years for CTCL. PFS was 11 months for patients with T-LGLL, 1 year for AITL/PTCL, and 12.37 years for CTCL. Survival probability is shown in Figure 1. The rates of progression, OS, and PFS were consistent with previously published data for patients with these T-cell malignancies. Conclusions: Herein, we characterize a cohort of patients with concomitant T-cell malignancies and PCD with an emphasis on survival outcomes. Our data suggests that there is no PFS or OS difference for patients with T-cell malignancies and concomitant PCD when treated with standard T-cell directed therapy. There is the potential that treating a patient's T-cell malignancy may lead to resolution of their PCD clone, even without therapy directed at the PCD. While our data is limited by small sample size, this report represents the largest data set available in this rarely described patient population. Larger retrospective cohort studies are needed to further characterize this population and validate these findings. For patients with T-cell malignancies as the primary diagnosis with concomitant PCD, treatment with standard T-cell directed therapies is recommended with continued follow-up and monitoring of the concomitant PCD. Figure 1 Figure 1. Disclosures Bumma: Sanofi: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees. Porcu: Viracta: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Innate Pharma: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; BeiGene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Incyte: Research Funding; Daiichi: Honoraria, Research Funding; Kiowa: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Spectrum: Consultancy; DrenBio: Consultancy. Brammer: Seattle Genetics: Speakers Bureau; Celgene: Research Funding; Kymera Therapeutics: Consultancy.
- Published
- 2021
38. Effect of Age on Outcomes of Allogeneic Transplantation in Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome
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Nicole Grieselhuber, Marcos de Lima, Karilyn Larkin, Justin Jiang, Jonathan E. Brammer, Samantha Jaglowski, Audrey M. Sigmund, Qiuhong Zhao, Maria Chaudhry, Naresh Bumma, Abdullah Khan, Srinivas Devarakonda, Alice S. Mims, Nidhi Sharma, Sam Penza, Yvonne A. Efebera, Hannah Choe, Ashley E. Rosko, Sumithira Vasu, Patrick Elder, Sarah A Wall, Don M. Benson, and Ayman Saad
- Subjects
Oncology ,medicine.medical_specialty ,Allogeneic transplantation ,business.industry ,Immunology ,Myeloid leukemia ,Cell Biology ,Hematology ,Biochemistry ,hemic and lymphatic diseases ,Internal medicine ,medicine ,In patient ,business - Abstract
Background: Allogeneic stem cell transplantation (allo-SCT) has become an increasingly important consolidation treatment option for patients with acute myeloid leukemia (AML) and as upfront therapy for patients with high-risk myelodysplastic syndrome (MDS). Although the median age at diagnosis for both diseases is above 65 years, studies evaluating allo-SCT as treatment option for patients aged 65 years or older are limited. Further, as the population ages, the number of patients above 65 years considered for allo-SCT will continue to rise. Thus, the aim of our current investigation was to analyze outcomes based on age in AML/MDS patients Methods: A retrospective analysis was performed for all AML/MDS patients who received allo-SCT between January 1984 and December 2018 at our institution. Primary endpoints included progression free survival (PFS) and overall survival (OS). PFS was counted from the day of transplantation to relapse or death. OS was defined as survival from the day of allo-SCT until death from any cause, with censoring of patients known to be alive at the time of last follow-up. PFS and OS were calculated using Kaplan Meier Curves. Secondary endpoints included cumulative incidences of grade II-IV and III-IV acute GVHD (aGVHD), chronic GVHD (cGVHD), relapse, and non-relapse mortality (NRM). Cumulative incidence rates of aGVHD, cGVHD, relapse, NRM were estimated and compared using Gray's test accounting for competing risks. Results: The cohort consisted of 900 AML/MDS patients, with 150 patients ≥65 years and 750 patients The median time from diagnosis to transplantation was 176 days (range: 55-4920) for age Conclusion: Overall, our study suggests similar outcomes for elderly patients undergoing allo-HCT as compared to their counterparts, which is in line with prior studies. This likely is due to advancements in the transplant field, including the development of RIC and alternative donors, which have allowed greater access to transplant for older adults. Utilization of allo-HCT is feasible and should be considered for AML/MDS patients ≥65 years. Further research is underway to evaluate the important determinants of health status in older patients undergoing allo-HCT and to ultimately help predict NRM (BMT CTN 1704). Figure 1 Figure 1. Disclosures Bumma: Amgen, Sanofi: Speakers Bureau; Janssen, Oncopeptides, Sanofi: Consultancy. Vasu: Seattle Genetics: Other: travel support; Boehringer Ingelheim: Other: Travel support; Kiadis, Inc.: Research Funding; Omeros, Inc.: Membership on an entity's Board of Directors or advisory committees. Jaglowski: Takeda: Consultancy; Juno: Consultancy; Kite, a Gilead Company: Consultancy, Research Funding; CRISPR Therapeutics: Consultancy; Novartis: Consultancy, Research Funding. Mims: Syndax Pharmaceuticals: Consultancy; BMS: Consultancy; Jazz Pharmaceuticals: Consultancy; Abbvie: Consultancy; Genentech: Consultancy; Kura Oncology: Consultancy; Leukemia and Lymphoma Society: Consultancy; Glycomemetics: Research Funding; Aptevo: Research Funding; Xencor: Research Funding; Daiichi-Saynko: Consultancy. Brammer: Celgene: Research Funding; Seattle Genetics: Speakers Bureau; Kymera Therapeutics: Consultancy. Saad: Incyte Pharmaceuticals: Consultancy; careDx: Consultancy; Amgen: Research Funding; Kadmon: Research Funding; OrcaBio: Research Funding; Magenta Therapeutics: Consultancy. de Lima: Miltenyi Biotec: Research Funding; Incyte: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees.
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- 2021
39. Interval Progression Serves As a Predictor of Adverse Outcomes in Patients with Multiple Myeloma
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Don M. Benson, Ashley E. Rosko, Qiuhong Zhao, Srinivas Devarakonda, Alicia Bao, Nidhi Sharma, Naresh Bumma, Abdullah Khan, and Francesca Cottini
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Oncology ,medicine.medical_specialty ,Adverse outcomes ,business.industry ,Immunology ,Cell Biology ,Hematology ,medicine.disease ,Biochemistry ,Internal medicine ,medicine ,Interval (graph theory) ,In patient ,business ,Multiple myeloma - Abstract
Background: Multiple myeloma (MM) remains an incurable disease, but deep, lasting remission can be achieved with induction therapy and autologous stem cell transplant (ASCT). The current ASCT treatment timeline includes a gap between the end of induction and the day of ASCT to permit correct mobilization and collection of stem cells. During this interval, some patients experience increases in their MM markers. We specifically evaluated if patients with interval progression (IP) have different outcomes post-ASCT compared to patients without IP. Methods: We completed a retrospective analysis of 482 patients who underwent ASCT at The Ohio State University Wexner Medical Center between 2011 and 2016. MM labs, including protein electrophoresis with immunofixation and free light chains, were obtained at day of diagnosis, end of induction, and day of ASCT. A 20% increase in the index protein between the end of induction and the day of ASCT was defined as IP. The primary outcomes evaluated were time-to-progression (TTP), progression-free survival (PFS), and overall survival (OS). TTP was defined as time from ASCT to disease progression, treating death without progression as a competing risk. PFS was defined as the time from ASCT until either disease progression or death, while OS was defined as the time from ASCT until death or last follow-up. Poisson regression models with robust variance were used to evaluate the associations between patients' characteristics and IP, while competing risk regression models were used for TTP analysis, and Cox regression models for OS and PFS analysis. Results: 482 patients who underwent ASCT for MM between 2011 and 2016 were studied. The patient population was primarily male (n = 296, 61.4%), Caucasian (n = 420, 87.1%), and had IgG disease (n = 269, 55.8%). MM stage at diagnosis was equally represented. Cytogenetic analysis showed 108 (22.4%) patients with 1q21 amplification, 60 (12.4%) patients with t(11;14) translocation, 33 (6.8%) patients with t(4;14) translocation, and 40 (8.3%) patients with 17p deletion. More than 80% of patients underwent maintenance therapy following ASCT. One hundred and fifty-six (32.3%) patients were defined as having IP. Patients in the IP group were significant more likely to have LC disease (p = 0.0018), but no other patient characteristics varied significantly between the two groups. LC disease (relative risk (RR adj) = 2.12, 95% CI 1.37-3.30, p = 0.001) and deletion 17p (RR adj = 1.62, 95% CI 1.08-2.42, p = 0.02) were associated with increased risk of IP on multivariate analysis (MVA). Five-year PFS rates were 47.2% and 36.8% in the non-IP and IP groups, respectively. Five-year cumulative progression rates were 49.0% in the non-IP group and 57.8% in the IP group. Five-year OS rates were 76.8% in the non-IP group and 69.6% in the IP group. On univariate analysis (UVA), IP correlated with inferior outcomes in both TTP (hazard ratio (HR) = 1.39, p = 0.01) and OS (HR = 1.39, p = 0.04). In agreement with previous literature, other factors independently correlated with inferior TTP and OS outcomes, including MM stage, cytogenetics (amp1q, t(4;14), and del(17p)), and absence of maintenance therapy post-ASCT. On MVA, IP was no longer significantly associated with a shorter TTP (HR = 1.16, p = 0.35), but approached statistical significance in conferring inferior OS (HR = 1.40, p = 0.07). Notably, once deletion 17p was removed from the MVA, the presence of IP once again conferred significantly lower OS (HR = 1.45, 95% CI 1.01-2.07, p = 0.04), suggesting that deletion 17p, which is a significant risk factor for both IP and OS, may mediate the effect of IP. Combined, all data suggest that uncontrolled disease prior to ASCT trends towards worse long-term outcomes. Conclusion: In this study, we report the first data regarding patients who experienced rapid disease progression in the interval between induction therapy and ASCT. These patients have inferior TTP, PFS, and OS, likely due to the presence of LC disease or deletion 17p. IP may provide a valuable predictor of robustness of response to ASCT and prompt the need for additional induction cycles or alternative regimens. This is especially relevant for patients with deletion 17p. Indeed, these data support a prospective study of concepts to improve outcomes for patients with IP prior to ASCT. Disclosures Bumma: Amgen: Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
- Published
- 2021
40. 477 COM902 (Anti-TIGIT antibody) monotherapy – preliminary evaluation of safety, tolerability, pharmacokinetics and receptor occupancy in patients with advanced solid tumors (NCT04354246)
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Robina Smith, Ecaterina Ileana Dumbrava, Manish Sharma, Adeboye H. Adewoye, Amita Patnaik, Srinivas Devarakonda, Drew W. Rasco, Kyriakos P. Papadopoulos, Ilan Vaknin, Daniel A. Vaena, Pierre Ferré, and Adam C. ElNaggar
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Pharmacology ,Oncology ,Cancer Research ,medicine.medical_specialty ,education.field_of_study ,Performance status ,business.industry ,Nausea ,Immunology ,Population ,Clinical trial ,TIGIT ,Pharmacokinetics ,Tolerability ,Internal medicine ,Molecular Medicine ,Immunology and Allergy ,Medicine ,medicine.symptom ,business ,education ,Adverse effect - Abstract
BackgroundCOM902 is an IgG4 fully human high-affinity monoclonal antibody, inhibitor of TIGIT (T cell Ig and immunoreceptor tyrosine-based inhibitory motif [ITIM] domain) binding to poliovirus receptor (PVR). TIGIT blockade by COM902 was shown to enhance anti-tumor immunity in pre-clinical models. We hypothesized that COM902 as monotherapy will have an acceptable safety and tolerability profile in subjects with advanced solid tumors.MethodsUtilizing an accelerated titration and 3+3 study design we enrolled 18 patients (pts) at the following COM902 doses 0.01, 0.03, 0.1, 0.3, 1, 3 and 10 mg/kg IV Q3 wks. Key primary objectives were to evaluate the safety, tolerability (CTCAE v5.0), to characterize the pharmacokinetics (PK) and to select a recommended dose for expansion (RDFE). An exploratory objective was evaluation of peripheral receptor occupancy (RO). Key inclusion criteria: Age ≥18 yrs, histologically/cytologically confirmed advanced malignancy who have exhausted all available standard therapy or not a candidate for standard therapy. Patients with performance status ECOG 0-1, prior ICI permissible. Dose-limiting toxicities (DLTs) were evaluated within a 21-day window in the 1st cycle of dose escalation.ResultsIn the safety population [N=18], 12 pts reported treatment emergent adverse events (TEAEs). The most frequent TEAES [≥2pts] were fatigue 7 pts (39%) all G1/2, diarrhea 3 pts (17%) all G1/2. Two pts reported DLTs deemed related to study drug, a pt with G2 nausea (single pt cohort, 0.01 mg/kg) and a pt with G3 atrial fibrillation (1 mg/kg). Serious adverse events were reported in 2 pts, 1 pt with atrial fibrillation (deemed by the investigator as possibly related to COM902) and 1 pt with spinal cord compression (deemed by the investigator as unrelated to COM902, related to disease). Preliminary PK profiles were generally dose proportional and peripheral RO above 90% was reported from 0.1 mg/kg dose.ConclusionsCOM902 has an acceptable safety, tolerability and PK profiles. A COM902 3 mg/kg IV Q3 wks is the RDFE. Enrollment into combination cohort (COM902 + COM701), for evaluation of safety/tolerability at the RDFE of both study drugs, combination dose expansion (COM902 + COM701) in pts with HNSCC, NSCLC and CRC-MSS and COM902 monotherapy dose expansion (pts with multiple myeloma) all at the RDFE of study drug(s) are planned. Data cut June 28, 2021.Trial RegistrationNCT04354246Ethics ApprovalThe study obtained approval from IRBs of the participating clinical trial sites. The study participants gave informed consent before taking part.o 0002: MOD01006350 (START)o 0003: 20202320 (West Cancer Center)o 0012: 2020–0195 (MDACC)o 0013: MOD01006350 (START midwest)o 0014: 20202320 (OSU)
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- 2021
41. Coexisting multiple myeloma, lymphoma, and non-small cell lung cancer: a case report and review of the literature
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Parth Khade and Srinivas Devarakonda
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Pathology ,medicine.medical_specialty ,Squamous-cell carcinoma of the lung ,business.industry ,Plasma cell dyscrasia ,coexisting ,Case Report ,General Medicine ,Lymphocyte proliferation ,medicine.disease ,non-Hodgkin’s lymphoma ,Lymphoma ,multiple myeloma ,03 medical and health sciences ,lung cancer ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Plasmacytoma ,business ,Lung cancer ,Multiple myeloma ,030215 immunology ,Lenalidomide ,medicine.drug - Abstract
Multiple myeloma is a plasma cell dyscrasia characterized by neoplastic proliferation of plasma cells, producing a monoclonal immunoglobulin. Small lymphocytic lymphoma (SLL) is a neoplasm consisting of monoclonal B-cell lymphocyte proliferation. We present an extremely rare case of coexisting multiple myeloma, SLL, and squamous cell carcinoma of the lung in a 74-year-old female patient. She initially presented with a midline mass with pain in the lumbar area. Debulking surgery was performed, and pathology showed plasmacytoma. Further evaluation revealed coexistent IgG kappa myeloma. Imaging revealed extensive abdominal lymphadenopathy, and mesenteric lymph node biopsy confirmed the presence of SLL. The patient was also found to have a mass in the left lower lobe of the lung; biopsy showed squamous cell carcinoma. This patient was treated with lenalidomide and dexamethasone for multiple myeloma, and stereotactic body radiotherapy for limited stage lung cancer. Due to the more indolent course of SLL, watchful waiting was applied.
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- 2017
42. Outcomes in Allogeneic Transplant Based on Race and Geographic Location of Residence
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Karilyn Larkin, Audrey M. Sigmund, Qiuhong Zhao, Sarah A Wall, Samantha Jaglowski, Don M. Benson, Yvonne A. Efebera, Justin Jiang, Nicole Grieselhuber, Maria Chaudhry, Patrick Elder, Alice S. Mims, Srinivas Devarakonda, Ashley E. Rosko, Hannah Choe, Sam Penza, Nidhi Sharma, Naresh Bumma, Abdullah Khan, Ayman Saad, Sumithira Vasu, Basem M. William, and Jonathan E. Brammer
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Transplantation ,Race (biology) ,Geography ,Molecular Medicine ,Immunology and Allergy ,Residence ,Cell Biology ,Hematology ,Location ,Demography - Published
- 2021
43. Impact of Bone Marrow Versus Peripheral Blood on Outcomes in Haploidentical Transplantation
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Yvonne A. Efebera, Ashley E. Rosko, Sumithira Vasu, Sam Penza, Nicole Grieselhuber, Sarah A Wall, Karilyn Larkin, Samantha Jaglowski, Alice S. Mims, Maria Chaudhry, Don M. Benson, Audrey M. Sigmund, Srinivas Devarakonda, Qiuhong Zhao, Nidhi Sharma, Hannah Choe, Patrick Elder, Jonathan E. Brammer, Naresh Bumma, Abdullah Khan, Basem M. William, Ayman Saad, and Justin Jiang
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Transplantation ,medicine.medical_specialty ,Haploidentical transplantation ,business.industry ,Cell Biology ,Hematology ,Peripheral blood ,Surgery ,medicine.anatomical_structure ,Molecular Medicine ,Immunology and Allergy ,Medicine ,Bone marrow ,business - Published
- 2021
44. Geriatric Assessment with Management Highlights Importance of Nutrition in Older Adult Transplant Recipients
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Sarah A. Wall, Ying Huang, Ashleigh Keiter, Colin Kloock, Nicholas Yuhasz, Allesia Funderburg, Carolyn Presley, Edmund Folefac, Sumithira Vasu, Samantha Jaglowski, Ayman Saad, Hannah Choe, Basem M. William, Yvonne A. Efebera, Jonathan E. Brammer, Naresh Bumma, Srinivas Devarakonda, Abdullah Khan, Karilyn Larkin, Sam Penza, Don M Benson, and Ashley Rosko
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Gerontology ,Transplantation ,business.industry ,Molecular Medicine ,Immunology and Allergy ,Medicine ,Geriatric assessment ,Cell Biology ,Hematology ,business - Published
- 2021
45. Outcomes of Patients after Allogeneic Transplant for Multiple Myeloma – a Single Center Retrospective Analysis
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Don M. Benson, Naresh Bumma, Abdullah Khan, Srinivas Devarakonda, Ashley Elizabeth Rosko, Ayman Saad, Yvonne Efebera, Muhammad Salman Faisal, and Maria Chaudhry
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Oncology ,Transplantation ,medicine.medical_specialty ,business.industry ,Cell Biology ,Hematology ,Single Center ,medicine.disease ,Internal medicine ,medicine ,Retrospective analysis ,Molecular Medicine ,Immunology and Allergy ,business ,Multiple myeloma - Published
- 2021
46. Trends in Survival of AML and MDS Patients Following Allogeneic Transplant
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Yvonne A. Efebera, Hannah Choe, Nicole Grieselhuber, Karilyn Larkin, Jonathan E. Brammer, Ayman Saad, Audrey M. Sigmund, Alice S. Mims, Qiuhong Zhao, Samantha Jaglowski, Sumithira Vasu, Srinivas Devarakonda, Patrick Elder, Maria Chaudhry, Basem M. William, Nidhi Sharma, Sarah A Wall, Sam Penza, Don M. Benson, Ashley E. Rosko, Naresh Bumma, Abdullah Khan, and Justin Jiang
- Subjects
Transplantation ,Molecular Medicine ,Immunology and Allergy ,Cell Biology ,Hematology - Published
- 2021
47. Impact of Chronic Graft-Versus-Host Disease on Non-Relapse Mortality and Survival
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Nicole Grieselhuber, Sam Penza, Jonathan E. Brammer, Yvonne A. Efebera, Sumithira Vasu, Maria Chaudhry, Justin Jiang, Audrey M. Sigmund, Hannah Choe, Qiuhong Zhao, Karilyn Larkin, Nidhi Sharma, Sarah A Wall, Alice S. Mims, Ashley E. Rosko, Ayman Saad, Samantha Jaglowski, Don M. Benson, Basem M. William, Srinivas Devarakonda, Patrick Elder, Naresh Bumma, and Abdullah Khan
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Transplantation ,medicine.medical_specialty ,business.industry ,Cell Biology ,Hematology ,medicine.disease ,Gastroenterology ,Graft-versus-host disease ,Internal medicine ,medicine ,Molecular Medicine ,Immunology and Allergy ,Nonrelapse mortality ,business - Published
- 2021
48. Comparison of Bone Marrow Versus Peripheral Blood in Haploidentical Transplantation Using Post-Transplant Cyclophosphamide- a Retrospective Analysis
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Sarah A Wall, Ayman Saad, Yvonne A. Efebera, Srinivas Devarakonda, Don M. Benson, Alice S. Mims, Audrey M. Sigmund, Qiuhong Zhao, Justin Jiang, Samantha Jaglowski, Nicole Grieselhuber, Basem M. William, Nidhi Sharma, Jonathan E. Brammer, Sam Penza, Maria Chaudhry, Patrick Elder, Sumithira Vasu, Ashley E. Rosko, Hannah Choe, Naresh Bumma, and Abdullah Khan
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medicine.medical_specialty ,Platelet Engraftment ,business.industry ,Immunology ,Retrospective cohort study ,Cell Biology ,Hematology ,medicine.disease ,Biochemistry ,law.invention ,Transplantation ,Leukemia ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Clinical endpoint ,Cumulative incidence ,Progression-free survival ,business - Abstract
Background: Allogeneic transplantation (allo-HCT) is a potentially curative treatment for a variety of hematologic malignancies and nonmalignant hematologic disorders. Allo-HCT from a haploidentical (Haplo) related donor has emerged as a suitable alternative in the absence of matched related donor (MRD) and matched unrelated donor (MUD). Haplo HCT patients however have higher risk of graft rejection and graft versus-host disease (GVHD). Thus, patients often receive post-transplant cyclophosphamide (PTCy), which has proven to be highly effective in reducing GVHD. While the use of peripheral blood is an attractive option due to the ease of collection and rapid peripheral blood count recovery, not much information is available on the impact of graft sources using PTCy in Haplo-HCT. This study compares outcomes of bone marrow (BM) versus peripheral blood (PB) stem cell graft for Haplo-HCT in adult patients. Methods: We performed a retrospective study of 81 adult patients who underwent Haplo-HCT at The Ohio State University from 2009 to 2018. The study endpoints were overall survival (OS), progression free survival (PFS), non-relapse mortality (NRM), relapse, engraftment, acute GVHD (grade II-IV), and chronic GVHD. All endpoints were measured from the time of transplantation. Patient, disease, and transplant-related characteristics were compared between the two groups (BM versus PB) using the Mann-Whitney U test for continuous variables, and chi-squared or Fisher's exact test for categorical variables. The probabilities of OS and PFS were calculated using the Kaplan-Meier (KM) method and compared using log-rank test. Cumulative incidence rates were estimated and compared using Gray's test accounting for competing risks. Results: We compared the outcomes of patients who received a BM graft (N=43) with those receiving a PB graft (N=38). The median age at transplant was 57 years (20-74). All patients received PTCy in addition to tacrolimus and mycophenolate in 91% of patients. Reduced intensity conditioning (RIC) was used in majority of patients (N=63, 78%). The two groups were comparable including age (median, 60 years for BM and 56 years for PB, p=0.60) and the type of conditioning regimen (79% RIC for BM, 76% RIC for PB, p=0.77). The number of CD34+ and CD3+ infused cells was higher in PB grafts (median, 8.6x106 CD34+ cells/Kg, 2.0 x108 CD3+ cells/Kg, respectively) than for BM (median, 3.7x106 CD34+cells/Kg, 0.4x108 CD3+cells/Kg, respectively). Time to neutrophil and platelet engraftment were significantly shorter in patients receiving PB versus those getting BM grafts: median 15 vs. 17.5 days, (p=0.02) and median 20 vs. 29 days (p Conclusion: Our study suggests peripheral blood for haploidentical transplant to be a good alternative to bone marrow. Similar PFS, OS and NRM were seen between the two graft sources. As expected, faster neutrophil and platelets engraftment were seen with PB due to more CD3+ and CD34+ infused, but without an increase in acute or chronic GVHD. A reduced relapse risk was observed with PB graft. Our study is small and is retrospective, but provide encouraging results. A prospective randomized controlled trial is required to confirm these results. Disclosures Chaudhry: Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees. Bumma:Sanofi: Speakers Bureau; Amgen: Speakers Bureau. Khan:Amgen: Consultancy; Janssen: Consultancy. Devarakonda:Janssen: Consultancy. Vasu:Kiadis Inc: Other: Kiadis has obtained exclusive licensing requirements from The OHio State University; Janssen: Membership on an entity's Board of Directors or advisory committees; Omeros: Membership on an entity's Board of Directors or advisory committees. Jaglowski:Novartis: Consultancy, Research Funding; Juno: Consultancy; Kite, a Gilead Company: Consultancy, Research Funding; CRISPR: Consultancy. William:Seattle Genetics: Research Funding; Merck: Research Funding; Dova: Research Funding; Kyowa Kirin: Consultancy, Honoraria; Guidepoint Global: Consultancy; Incyte: Research Funding; Celgene: Consultancy, Honoraria. Mims:Jazz Pharmaceuticals: Other: Data Safety Monitoring Board; Abbvie: Membership on an entity's Board of Directors or advisory committees; Syndax Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Kura Oncology: Membership on an entity's Board of Directors or advisory committees; Leukemia and Lymphoma Society: Other: Senior Medical Director for Beat AML Study; Agios: Consultancy; Novartis: Speakers Bureau. Brammer:Bristol-Myers Squibb: Research Funding; Celgene: Research Funding; Seattle Genetics: Honoraria, Speakers Bureau; Kymera: Honoraria; Verastem Oncology: Other: Travel. Saad:Amgen: Other: research support; Magenta Therapeutics: Other: Personal Fees; Incyte Pharmaceuticals: Other: Personal Fees; Orcabio: Other: research support; Kadmon: Other: research support. Efebera:Celgene: Research Funding; Ohio State University: Current Employment; Takeda: Honoraria, Speakers Bureau; Pharmacyclics: Research Funding.
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- 2020
49. Survival Implications of Opioid Use after Blood and Marrow Transplantation
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Jonathan E. Brammer, Karilyn Larkin, Qiuhong Zhao, Sam Penza, Naresh Bumma, Abdullah Khan, Nicole Grieselhuber, Ayman Saad, Yvonne A. Efebera, Samantha Jaglowski, Srinivas Devarakonda, Hannah Choe, Bradley W. Blaser, Maria Chaudhry, Ashley E. Rosko, Alice S. Mims, Ashleigh Keiter, Julianna Roddy, Patrick Elder, Basem M. William, Sarah A Wall, Sumithra Vasu, Noha N. Soror, and Don M. Benson
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medicine.medical_specialty ,education.field_of_study ,Proportional hazards model ,business.industry ,Public health ,Immunology ,Hazard ratio ,Population ,Opioid use disorder ,Cell Biology ,Hematology ,medicine.disease ,Biochemistry ,Internal medicine ,medicine ,Data monitoring committee ,Cumulative incidence ,Progression-free survival ,education ,business - Abstract
B ackground Premature death from opioid-related causes imposes an enormous public health burden across the United States. Between 2001 and 2016, the number of opioid-related deaths in the United States increased by 345%, from 9489 to 42 245 deaths (33.3 to 130.7 deaths per million population. Moreover, opioids may have immunosuppressive properties independent of their psychotropic effects; opioid use has been associated with increased invasive pneumococcal disease in a nested case-control study of 1233 Medicaid patients from Tennessee. In liver transplant recipients, opioid use disorder has been associated with increased mortality after transplant. The impact of opioid use disorder on patients receiving blood and marrow transplant (BMT) remains to be defined. Methods We performed a retrospective analysis of all consecutive adult patients who had BMT (autologous and allogeneic) from 1/1/2008 through 1/1/2018 at the James Comprehensive Cancer Center. Overall survival (OS) was measured from the date of transplant to the date of death, censoring at date of last follow up if alive. Progression free survival (PFS) was measured from the date of transplant to the date of disease progression or the date of death, whichever occurred first, censoring at last follow up if no event. OS and PFS were estimated by the Kaplan-Meier method and compared using the log-rank test. Opioid use (OU) was defined as a binary yes/no variable if an opioid was prescribed upon discharge from the hospital after BMT. The impact of OU, along with other patient, disease, and BMT related factors, on PFS/OS, was analyzed using Cox regression method. Results A total of 1585 patients were included in the analysis (Table 1). The median age at BMT was 58 (range=18-79) years; 59% were males; 60% had autologous transplants; and 58% were prescribed opioids upon discharge from the hospital. OU was significantly more in patients who were younger, have had allogeneic transplant, reduced intensity conditioning, had acute myeloid leukemia (AML), or higher BMT comorbidity index (CMI). On univariable analysis, OU was not associated with cumulative incidence of relapse (CIR) or PFS however it was associated with inferior OS; hazard ratio (HR)=1.25, 95% CI: 1.06-1.49; p=0.01 (Figure-1). There were no differences in CIR, PFS, or OS when autologous and allogeneic transplants were analyzed separately. Upon multivariable analysis of OS, OU lost statistical significance after controlling for age, diagnosis, type of transplant, intensity of conditioning regimen, CMI, and disease risk index (DRE). Of interest, OU independently predicted for superior OS at 100 days and 365 days post-BMT; HR=0.29, 95% CI 0.16-0.50 (p= Conclusion: Our results suggest that opioid use (OU) may have a long term negative impact on survival in BMT patients. The apparently protective effects of OU early on after BMT is elusive but may be possibly related immunomodulatory effects of opioids. A major limitation of our study is that OU is analyzed at a single time point at hospital discharge after BMT. We plan to undertake a more detailed analysis of ongoing OU after discharge and its impact on survival outcomes after BMT. Disclosures Brammer: Celgene Corporation: Research Funding; Seattle Genetics, Inc.: Speakers Bureau. Efebera:Celgene: Research Funding; Ohio State University: Current Employment; Pharmacyclics: Research Funding; Takeda: Honoraria, Speakers Bureau. Mims:Abbvie: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Other: Data Safety Monitoring Board; Syndax Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Kura Oncology: Membership on an entity's Board of Directors or advisory committees; Leukemia and Lymphoma Society: Other: Senior Medical Director for Beat AML Study; Agios: Consultancy; Novartis: Speakers Bureau. Chaudhry:Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees. Bumma:Sanofi: Speakers Bureau; Amgen: Speakers Bureau. Khan:Amgen: Consultancy; Janssen: Consultancy. Devarakonda:Janssen: Consultancy. Jaglowski:Novartis: Consultancy, Research Funding; CRISPR: Consultancy; Juno: Consultancy; Kite, a Gilead Company: Consultancy, Research Funding. William:Kyowa Kirin: Consultancy, Honoraria; Merck: Research Funding; Seattle Genetics: Research Funding; Incyte: Research Funding; Guidepoint Global: Consultancy; Dova: Research Funding; Celgene: Consultancy, Honoraria.
- Published
- 2020
50. Impact of Race and Geographic Location on Outcomes in Allogeneic Transplant
- Author
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Alice S. Mims, Audrey M. Sigmund, Sarah A Wall, Qiuhong Zhao, Ashley E. Rosko, Nicole Grieselhuber, Don M. Benson, Srinivas Devarakonda, Justin Jiang, Hannah Choe, Nidhi Sharma, Jonathan E. Brammer, Patrick Elder, Naresh Bumma, Abdullah Khan, Samantha Jaglowski, Sam Penza, Maria Chaudhry, Basem M. William, Ayman Saad, Sumithira Vasu, Karilyn Larkin, and Yvonne A. Efebera
- Subjects
Referral ,business.industry ,Immunology ,Retrospective cohort study ,Cell Biology ,Hematology ,Biochemistry ,Health equity ,Underserved Population ,Cohort ,Medicine ,Residence ,Progression-free survival ,Rural area ,business ,Demography - Abstract
Introduction: Allogeneic hematopoietic stem cell transplant (allo-HCT) is a potential curative therapy for a variety of both malignant and nonmalignant hematologic disorders. However, allo-HCT is costly and requires highly specialized, technologically advanced care that is only available in select healthcare centers across the country. Due to its cost and limited availability, minority populations are at risk for healthcare disparities in access to and outcomes of allo-HCT. Prior studies have focused on the impact of health disparities, including race, and geographic residence at time of transplant, on allo-HCT outcomes with variable results. The aim of this study was to evaluate the impact of race and location of residence on outcomes of allo-HCT at one major referral institution. Methods: We performed a retrospective cohort study of patients that underwent allo-HCT at the Ohio State University from 1984 to 2018. The impact of demographic factors including race and place of primary residence were assessed. Patients were divided into race defined as Caucasian, African American (AA), and other. They were also grouped by zip code into rural, suburban, and urban groups. Rural was defined as less than 1000 people per square mile, suburban between 1000-3000 people per square mile, and urban greater than 3000 people per square mile. 2018 population estimates were used. Patients were then stratified into 7 groups based on year (yr) of transplant for analysis. Group (gp) 1 included 1984-1988, gp 2 1989-1993, gp 3 1994-1998, gp 4 1999-2003, gp 5 2004-2008, gp 6 2009-2013, and gp 7 2014-2018. Primary endpoints were progression free survival (PFS) and overall survival (OS). PFS and OS were calculated using Kaplan Meier Curves and compared using log-rank test between race and residence groups. Results: A total of 1,943 patients were included in the study. Of these patients, median age at time of transplant was 50 years old (range 18-76), and 59.6% were male. AML/MDS patients made up the majority of the cohort at 46.3%, with the other most common diagnoses being non-Hodgkin's lymphoma (14.2%), acute lymphocytic leukemia (11.8%), and chronic myeloid leukemia (10.1%). Most patients (94.3%) identified as Caucasian, while 4.6% identified as AA, and 1.1% other. The majority of patients lived in a rural area at the time of transplant with 63.4% rural, 22.9% suburban, and 13.8% urban. There was no significant difference in OS or PFS between Caucasian and AA patients (Figure 1A and B; p=0.15, 0.21). Median OS for AA was 1.9 yrs [95% confidence interval (CI): 0.8-3.6] as compared to 2.3 yrs (95% CI: 1.9-2.9) for Caucasians, with 5 -yr OS of 33 vs. 42% and 10-yr OS of 21 vs. 36% for AA and Caucasian, respectively. Median PFS was 0.9 (95% CI: 0.5-2.7) and 1.3 yrs (95% CI 1.1-1.6), with 5 -yr PFS of 30 vs. 37% and 10-yr PFS of 21 vs. 32% for AA and Caucasian, respectively. There also was no significant difference in OS or PFS between rural, urban, and suburban patients (Figure 2A and 2B; p=0.39, 0.17), with median OS in the three groups 2.2 (95%CI: 1.7-2.9), 2.9 (95%CI: 1.6-4.5), and 2.2 (95% CI: 1.6-3.6) yrs, and 5-yr OS of 40 vs. 43 vs. 43% and 10-yr OS of 33 vs. 39 vs. 39%, respectively. Median PFS were 2.2 (95%CI: 1.7-2.9), 2.9 (95%CI: 1.6-4.5), and 2.2 yrs [95% CI: 1.6-3.6], with 5-yr PFS of 36 vs. 40 vs. 38% and 10-yr PFS of 30 vs. 37 vs. 35%, respectively. Conclusion: Our study suggests that once patients undergo allo-HCT, there is no significant difference in outcomes between patients based on race or residence. This finding suggests that while these underserved populations may initially have less access to specialized care for HCT, if they ultimately undergo allo-HCT, outcomes are similar to their counterparts. Our study did show a significantly lower rates of allo-HCT performed in non-Caucasian races (94% Caucasians vs 4.6% AA and 1% other), which may reflect disparities in access to care in these groups as well as a lack of donors. Further research is needed to assess the barriers for these underserved patients to undergo transplant and to help ameliorate these barriers. Disclosures Chaudhry: Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees. Bumma:Amgen: Speakers Bureau; Sanofi: Speakers Bureau. Khan:Amgen: Consultancy; Janssen: Consultancy. Devarakonda:Janssen: Consultancy. Vasu:Janssen: Membership on an entity's Board of Directors or advisory committees; Omeros: Membership on an entity's Board of Directors or advisory committees; Kiadis Inc: Other: Kiadis has obtained exclusive licensing requirements from The OHio State University. Jaglowski:Kite, a Gilead Company: Consultancy, Research Funding; Juno: Consultancy; Novartis: Consultancy, Research Funding; CRISPR: Consultancy. William:Merck: Research Funding; Celgene: Consultancy, Honoraria; Dova: Research Funding; Seattle Genetics: Research Funding; Incyte: Research Funding; Guidepoint Global: Consultancy; Kyowa Kirin: Consultancy, Honoraria. Mims:Syndax Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Kura Oncology: Membership on an entity's Board of Directors or advisory committees; Leukemia and Lymphoma Society: Other: Senior Medical Director for Beat AML Study; Agios: Consultancy; Novartis: Speakers Bureau; Jazz Pharmaceuticals: Other: Data Safety Monitoring Board. Brammer:Seattle Genetics, Inc.: Speakers Bureau; Celgene Corporation: Research Funding. Efebera:Celgene: Research Funding; Pharmacyclics: Research Funding; Takeda: Honoraria, Speakers Bureau; Ohio State University: Current Employment.
- Published
- 2020
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