Browsing by Author "Bachanova, Veronika"

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    Impact of cytogenetic abnormalities on outcomes of adult Philadelphia-negative acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: a study by the Acute Leukemia Working Committee of the Center for International Blood and Marrow Transplant Research
    (Ferrata Storti Foundation, 2019-09-26) Lazaryan, Aleksandr; Dolan, Michelle; Zhang, Mei-Jie; Wang, Hai-Lin; Kharfan-Dabaja, Mohamed A.; Marks, David I.; Bejanyan, Nelli; Copelan, Edward; Majhail, Navneet S.; Waller, Edmund K.; Chao, Nelson; Prestidge, Tim; Nishihori, Taiga; Kebriaei, Partow; Inamoto, Yoshihiro; Hamilton, Betty; Hashmi, Shahrukh K.; Kamble, Rammurti T.; Bacher, Ulrike; Hildebrandt, Gerhard C.; Stiff, Patrick J.; McGuirk, Joseph; Aldoss, Ibrahim; Beitinjaneh, Amer M.; Muffly, Lori; Vij, Ravi; Olsson, Richard F.; Byrne, Michael; Schultz, Kirk R.; Aljurf, Mahmoud; Seftel, Matthew; Savoie, Mary Lynn; Savani, Bipin N.; Verdonck, Leo F.; Cairo, Mitchell S.; Hossain, Nasheed; Bhatt, Vijaya Raj; Frangoul, Haydar A.; Abdel-Azim, Hisham; Al Malki, Monzr; Munker, Reinhold; Rizzieri, David; Khera, Nandita; Nakamura, Ryotaro; Ringdén, Olle; van der Poel, Marjolein; Murthy, Hemant S.; Liu, Hongtao; Mori, Shahram; De Oliveira, Satiro; Bolaños-Meade, Javier; Elsawy, Mahmoud; Barba, Pere; Nathan, Sunita; George, Biju; Pawarode, Attaphol; Grunwald, Michael; Agrawal, Vaibhav; Wang, Youjin; Assal, Amer; Castillo Caro, Paul; Kuwatsuka, Yachiyo; Seo, Sachiko; Ustun, Celalettin; Politikos, Ioannis; Lazarus, Hillard M.; Saber, Wael; Sandmaier, Brenda M.; De Lima, Marcos; Litzow, Mark; Bachanova, Veronika; Weisdorf, Daniel; Acute Leukemia Committee of the CIBMTR; Medicine, School of Medicine
    Cytogenetic risk stratification at diagnosis has long been one of the most useful tools to assess prognosis in acute lymphoblastic leukemia (ALL). To examine the prognostic impact of cytogenetic abnormalities on outcomes after allogeneic hematopoietic cell transplantation, we studied 1731 adults with Philadelphia-negative ALL in complete remission who underwent myeloablative or reduced intensity/non-myeloablative conditioning transplant from unrelated or matched sibling donors reported to the Center for International Blood and Marrow Transplant Research. A total of 632 patients had abnormal conventional metaphase cytogenetics. The leukemia-free survival and overall survival rates at 5 years after transplantation in patients with abnormal cytogenetics were 40% and 42%, respectively, which were similar to those in patients with a normal karyotype. Of the previously established cytogenetic risk classifications, modified Medical Research Council-Eastern Cooperative Oncology Group score was the only independent prognosticator of leukemia-free survival (P=0.03). In the multivariable analysis, monosomy 7 predicted post-transplant relapse [hazard ratio (HR)=2.11; 95% confidence interval (95% CI): 1.04-4.27] and treatment failure (HR=1.97; 95% CI: 1.20-3.24). Complex karyotype was prognostic for relapse (HR=1.69; 95% CI: 1.06-2.69), whereas t(8;14) predicted treatment failure (HR=2.85; 95% CI: 1.35-6.02) and overall mortality (HR=3.03; 95% CI: 1.44-6.41). This large study suggested a novel transplant-specific cytogenetic scheme with adverse [monosomy 7, complex karyotype, del(7q), t(8;14), t(11;19), del(11q), tetraploidy/near triploidy], intermediate (normal karyotype and all other abnormalities), and favorable (high hyperdiploidy) risks to prognosticate leukemia-free survival (P=0.02). Although some previously established high-risk Philadelphia-negative cytogenetic abnormalities in ALL can be overcome by transplantation, monosomy 7, complex karyotype, and t(8;14) continue to pose significant risks and yield inferior outcomes.
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    Transplant Physicians’ Attitudes on Candidacy for Allogeneic Hematopoietic Cell Transplantation (HCT) in Older Patients: The Need for a Standardized Geriatric Assessment (GA) Tool
    (Elsevier, 2020-03) Mishra, Asmita; Preussler, Jaime M.; Al-Mansour, Zeina; Bachanova, Veronika; Bhatt, Vijaya Raj; Bredeson, Christopher; Chhabra, Saurabh; D’Souza, Anita; Dahi, Parastoo B.; DeFilipp, Zack; Gowda, Lohith; Danaher Hacker, Eileen; Hashmi, Shahrukh K.; Howard, Dianna S.; Jakubowski, Ann A.; Jayani, Reena; Johnston, Laura; Koll, Thuy; Lin, Richard J.; McCurdy, Shannon R.; Michaelis, Laura C.; Muffly, Lori; Nathwani, Nitya; Olin, Rebecca L.; Popat, Uday R.; Rodriguez, Cesar; Rosko, Ashley; Runaas, Lyndsey; Sabloff, Mitchell; Shore, Tsiporah B.; Shune, Leyla; Sorror, Mohamed L.; Sung, Anthony D.; Ustun, Celalettin; Wood, William; Burns, Linda J.; Artz, Andrew S.; School of Nursing
    Background Despite improvements in conditioning regimens and supportive care having expanded the curative potential of HCT, underutilization of HCT in older adults persists (Bhatt VR et al, BMT 2017). Therefore, we conducted a survey of transplant physicians (TP) to determine their perceptions of the impact of older age (≥60 years) on HCT candidacy and utilization of tools to gauge candidacy. Methods We conducted a 23-item, online cross-sectional survey of adult physicians recruited from the Center for International Blood and Marrow Transplant Research between May and July 2019. Results 175/770 (22.7%) TP completed the survey; majority of respondents were 41-60 years old, male, and practicing in a teaching hospital. Over 75% were at centers performing ≥50 HCT per year. When considering regimen intensity, most (96%, n=168) had an upper age limit (UAL) for using a myeloablative regimen (MAC), with only 29 physicians (17%) stating they would consider MAC for patients ≥70 years. In contrast, when considering a reduced intensity/non-myeloablative conditioning (RIC/NMA), 8%, (n=13), 54% (n=93), and 20% (n=35) stated that age 70, 75, and 80 years respectively would be the UAL to use this approach, with 18% (n=31) reporting no UAL. TP agreed that Karnofsky Performance Score (KPS) could exclude older pts for HCT, with 39.1% (n=66), 42.6% (n=72), and 11.4% (n=20) requiring KPS of ≥70, 80, and 90, respectively. The majority (n=92, 52.5%) indicated an HCT-comorbidity index threshold for exclusion, mostly ranging from ≥3 to ≥ 5. Almost all (89.7%) endorsed the need for a better health assessment of pre-HCT vulnerabilities to guide candidacy for pts ≥60 with varied assessments being utilized beyond KPS (Figure 1). However, the majority of centers rarely (33.1%) or never (45.7%) utilize a dedicated geriatrician/geriatric-oncologist to assess alloHCT candidates ≥60 yrs. The largest barriers to performing GA included uncertainty about which tools to use, lack of knowledge and training, and lack of appropriate clinical support staff (Figure 2). Approximately half (n=78, 45%) endorsed GA now routinely influences candidacy. Conclusions The vast majority of TP will consider RIC/NMA alloHCT for patients ≥70 years. However, there is heterogeneity in assessing candidacy. Incorporation of GA into a standardized and easily applied health assessment tool for risk stratification is an unmet need. The recently opened BMT CTN 1704 may aid in addressing this gap.