Browsing by Author "Aftandilian, Catherine"

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    Pediatric relapsed/refractory ALK-positive anaplastic large cell lymphoma treatment and outcomes in the targeted-drug era
    (American Society of Hematology, 2025) Marks, Lianna J.; Ritter, Victor; Agrusa, Jennifer E.; Kamdar, Kala Y.; Rivers, Julie; Gardner, Rebecca; Ehrhardt, Matthew J.; Devine, Kaitlin J.; Phillips, Charles A.; Reilly, Anne; August, Keith; Weinstein, Joanna; Satwani, Prakash; Forlenza, Christopher J.; Moore Smith, Christine; Greer, Chelsee; Afify, Zeinab; Lin, Carol H.; Belsky, Jennifer A.; Ding, Hilda; Hoogstra, David; Toner, Keri; Link, Michael P.; Schultz, Liora M.; Lowe, Eric J.; Aftandilian, Catherine; Pediatrics, School of Medicine
    Treatment options for patients with relapsed or refractory (R/R) anaplastic large cell lymphoma (ALCL) have increased in the era of targeted therapies such as brentuximab vedotin (BV) and anaplastic lymphoma kinase (ALK) inhibitors. However, there is no standard treatment and published data evaluating their use are limited. The goal of this retrospective study was to describe current real-world treatment and outcomes of pediatric, adolescent, and young adult patients with R/R ALK-positive ALCL. We conducted a retrospective, multi-institutional study identifying 81 patients with R/R ALK-positive ALCL aged ≤21 years at initial diagnosis treated between 2011 and 2022 across 18 institutions. Median time from diagnosis to relapse was 8.9 months (range, 2.6-131.9). Initial reinduction regimens included ALK-inhibitor monotherapy (n = 37, 46%), BV monotherapy (n = 19, 23%), chemotherapy without targeted therapy (n = 12, 15%), chemotherapy with targeted therapy (n = 9, 11%), or vinblastine monotherapy (n = 4, 5%), with 83% of patients achieving a complete response to initial reinduction regimen. Fifty-eight patients received a hematopoietic stem cell transplant (HSCT), 11 autologous and 48 allogeneic, with 1 receiving both. Duration of treatment for patients receiving BV or the ALK-inhibitor crizotinib (CZ) varied widely (BV, 1-11 years; CZ, 2-10 years). Five-year event-free survival was 63% (95% confidence interval [CI], 53-75) and 5-year overall survival was 91% (95% CI, 84-98). This is, to our knowledge, the largest collection of patients with R/R ALK-positive ALCL treated in the era of targeted therapy. Patients achieved excellent responses to ALK-inhibitor or BV monotherapy, but questions remain about duration of therapy and role of HSCT.
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    Prospective External Validation of the Esbenshade Vanderbilt Models Accurately Predicts Bloodstream Infection Risk in Febrile Non-Neutropenic Children With Cancer
    (American Society of Clinical Oncology, 2024) Zhao, Zhiguo; Patel, Pratik A.; Slatnick, Leonora; Sitthi-Amorn, Anna; Bielamowicz, Kevin J.; Nunez, Farranaz A.; Walsh, Alexandria M.; Hess, Jennifer; Rossoff, Jenna; Elgarten, Caitlin; Myers, Regina; Saab, Raya; Basbous, Maya; Mccormick, Meghan; Aftandilian, Catherine; Richards, Rebecca; Nessle, C. Nathan; Tribble, Alison C.; Sheth Bhutada, Jessica K.; Coven, Scott L.; Runco, Daniel; Wilkes, Jennifer; Gurunathan, Arun; Guinipero, Terri; Belsky, Jennifer A.; Lee, Karen; Wong, Victor; Malhotra, Megha; Armstrong, Amy; Jerkins, Lauren P.; Cross, Shane J.; Fisher, Lyndsay; Stein, Madison T.; Wu, Natalie L.; Yi, Troy; Orgel, Etan; Haeusler, Gabrielle M.; Wolf, Joshua; Demedis, Jenna M.; Miller, Tamara P.; Esbenshade, Adam J.; Pediatrics, School of Medicine
    Purpose: The optimal management of fever without severe neutropenia (absolute neutrophil count [ANC] ≥500/µL) in pediatric patients with cancer is undefined. The previously proposed Esbenshade Vanderbilt (EsVan) models accurately predict bacterial bloodstream infections (BSIs) in this population and provide risk stratification to aid management, but have lacked prospective external validation. Materials and methods: Episodes of fever with a central venous catheter and ANC ≥500/µL occurring in pediatric patients with cancer were prospectively collected from 18 academic medical centers. Variables included in the EsVan models and 7-day clinical outcomes were collected. Five versions of the EsVan models were applied to the data with calculation of C-statistics for both overall BSI rate and high-risk organism BSI (gram-negative and Staphylococcus aureus BSI), as well as model calibration. Results: In 2,565 evaluable episodes, the BSI rate was 4.7% (N = 120). Complications for the whole cohort were rare, with 1.1% (N = 27) needing intensive care unit (ICU) care by 7 days, and the all-cause mortality rate was 0.2% (N = 5), with only one potential infection-related death. C-statistics ranged from 0.775 to 0.789 for predicting overall BSI, with improved accuracy in predicting high-risk organism BSI (C-statistic 0.800-0.819). Initial empiric antibiotics were withheld in 14.9% of episodes, with no deaths or ICU admissions attributable to not receiving empiric antibiotics. Conclusion: The EsVan models, especially EsVan2b, perform very well prospectively across multiple academic medical centers and accurately stratify risk of BSI in episodes of non-neutropenic fever in pediatric patients with cancer. Implementation of routine screening with risk-stratified management for non-neutropenic fever in pediatric patients with cancer could safely reduce unnecessary antibiotic use.