Browsing by Author "Elder, Patrick"

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    Addition of Infliximab to Standard Acute Graft-versus-Host Disease Prophylaxis following Allogeneic Peripheral Blood Cell Transplantation
    (Elsevier, 2008-07-01) Hamadani, Mehdi; Hofmeister, Craig C.; Jansak, Buffy; Phillips, Gary; Elder, Patrick; Blum, William; Penza, Sam; Lin, Thomas S.; Klisovic, Rebecca; Marcucci, Guido; Farag, Sherif S.; Devine, Steven M.; Medicine, School of Medicine
    Infliximab, a chimeric monoclonal antibody (mAb) against tumor necrosis factor (TNF)-α, has shown activity against steroid refractory acute graft-versus-host disease (aGVHD). We conducted a prospective trial of infliximab for the prophylaxis of aGVHD. Patients older than 20 years undergoing myeloablative allogeneic stem cell transplantation (SCT) for hematologic malignancies were eligible. GVHD prophylaxis consisted of infliximab given 1 day prior to conditioning and then on days 0, +7, +14, +28, and +42, together with standard cyclosporine (CSA) and methotrexate (MTX). Nineteen patients with a median age of 53 years were enrolled. All patients received peripheral blood allografts from matched sibling (n = 14) or unrelated donors (n = 5). Results were compared with a matched historic control group (n = 30) treated contemporaneously at our institution. The cumulative incidences of grades II-IV aGVHD in the infliximab and control groups were 36.8% and 36.6%, respectively (P = .77). Rates of chronic GVHD were 78% and 61%, respectively (P = .22). Significantly more bacterial and invasive fungal infections were observed in the infliximab group (P = .01 and P = .02, respectively). Kaplan-Meier estimates of 2-year overall survival (OS) and progression free survival (PFS) for patients receiving infliximab were 42% and 36%, respectively. The corresponding numbers for patients in the control group were 46% and 43%, respectively. The addition of infliximab to standard GVHD prophylaxis did not lower the risk of GVHD and was associated with an increased risk of bacterial and invasive fungal infections.
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    Long-term Outcome of Hodgkin Disease Patients Following High-Dose Busulfan, Etoposide, Cyclophosphamide, and Autologous Stem Cell Transplantation
    (Elsevier, 2006-12-01) Wadehra, Navin; Farag, Sherif; Bolwell, Brian; Elder, Patrick; Penza, Sam; Kalaycio, Matt; Avalos, Belinda; Pohlman, Brad; Marcucci, Guido; Sobecks, Ronald; Lin, Thomas; Andrèsen, Steven; Copelan, Edward; Medicine, School of Medicine
    Busulfan (Bu)-based preparative regimens have not been extensively investigated in Hodgkin disease (HD). The purposes of this study were to investigate the toxicity and efficacy of a novel preparative regimen of Bu 14 mg/kg, etoposide 50-60 mg/kg, and cyclophosphamide 120 mg/kg in patients with primary refractory and relapsed HD. One hundred twenty-seven patients with a median age of 33 years (range, 14-67 years) underwent transplantation. The regimen was well tolerated, with 5.5% treatment-related mortality at 100 days after transplantation. With a median follow up of 6.7 years, the 5-year progression-free survival was 48 ± 5%, and the 5-year overall survival was 51 ± 5%. A Cox proportional hazards model identified refractory disease at time of transplantation as the only significant factor affecting relapse and overall survival, whereas disease bulk >10 cm affected overall survival. Five patients died between 5.3 and 9.3 years of late complications, including secondary myelodysplasia or acute myeloid leukemia, secondary solid malignancies, and pulmonary toxicity. This novel Bu regimen is comparable to other radiation-free preparative regimens in its effectiveness in the control of HD and with a low-risk of early treatment-related mortality.