Browsing by Author "Sobecks, Ronald"

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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.
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    The Role of Donor Lymphocyte Infusion (DLI) in Post Hematopoietic Cell Transplant (HCT) Relapse for Chronic Myeloid Leukemia (CML) in the Tyrosine Kinase Inhibitor (TKI) Era
    (Elsevier, 2020-06) Schmidt, Sarah; Liu, Ying; Hu, Zhen-Huan; Williams, Kirsten M.; Lazarus, Hillard M.; Vij, Ravi; Kharfan-Dabaja, Mohamed A.; Ortí, Guillermo; Wiernik, Peter H.; Weisdorf, Daniel; Kamble, Rammurti T.; Herzig, Roger; Wirk, Baldeep; Cerny, Jan; Bacher, Ulrike; Chaudhri, Naeem A.; Nathan, Sunita; Farhadfar, Nosha; Aljurf, Mahmoud; Gergis, Usama; Szer, Jeffrey; Seo, Sachiko; Hsu, Jack W.; Olsson, Richard F.; Maharaj, Dipnarine; George, Biju; Hildebrandt, Gerhard C.; Agrawal, Vaibhav; Nishihori, Taiga; Abdel-Azim, Hisham; Alyea, Edwin; Popat, Uday; Sobecks, Ronald; Scott, Bart L.; Holter Chakrabarty, Jennifer; Saber, Wael; Medicine, School of Medicine
    Treatment for relapse of chronic myeloid leukemia (CML) following hematopoietic cell transplantation (HCT) includes tyrosine kinase inhibitors (TKIs) with or without donor lymphocyte infusions (DLIs), but the most effective treatment strategy is unknown. This study was performed through the Center for International Blood and Marrow Transplant Research (CIBMTR) database. We retrospectively reviewed all patients reported to the CIBMTR registry from 2002 to 2014 who underwent HCT for CML and were alive 30 days postrelapse. A total of 215 HCT recipients relapsed and were analyzed in the following groups: (1) TKI alone (n = 128), (2) TKI with DLI (n = 48), and (3) DLI without TKI (n = 39). In multivariate analysis, disease status prior to HCT had a significant effect on overall survival (OS). Patients who received a DLI alone compared with a TKI with a DLI had inferior survival (hazard ratio, 2.28; 95% confidence interval, 1.23 to 4.24; P= .009). Those who received a TKI alone had similar survival compared with those who received a TKI with a DLI (P = .81). These data support that despite use of TKIs pretransplantation, TKI salvage therapy continues to provide significant survival following relapse in patients with CML following HCT. These data do not suggest that adding a DLI to a TKI adds an improvement in OS.
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    Survival following allogeneic transplant in patients with myelofibrosis
    (American Society of Hematology, 2020-05-08) Gowin, Krisstina; Ballen, Karen; Ahn, Kwang Woo; Hu, Zhen-Huan; Ali, Haris; Arcasoy, Murat O.; Devlin, Rebecca; Coakley, Maria; Gerds, Aaron T.; Green, Michael; Gupta, Vikas; Hobbs, Gabriela; Jain, Tania; Kandarpa, Malathi; Komrokji, Rami; Kuykendall, Andrew T.; Luber, Kierstin; Masarova, Lucia; Michaelis, Laura C.; Patches, Sarah; Pariser, Ashley C.; Rampal, Raajit; Stein, Brady; Talpaz, Moshe; Verstovsek, Srdan; Wadleigh, Martha; Agrawal, Vaibhav; Aljurf, Mahmoud; Diaz, Miguel Angel; Avalos, Belinda R.; Bacher, Ulrike; Bashey, Asad; Beitinjaneh, Amer M.; Cerny, Jan; Chhabra, Saurabh; Copelan, Edward; Cutler, Corey S.; DeFilipp, Zachariah; Gadalla, Shahinaz M.; Ganguly, Siddhartha; Grunwald, Michael R.; Hashmi, Shahrukh K.; Kharfan-Dabaja, Mohamed A.; Kindwall-Keller, Tamila; Kröger, Nicolaus; Lazarus, Hillard M.; Liesveld, Jane L.; Litzow, Mark R.; Marks, David I.; Nathan, Sunita; Nishihori, Taiga; Olsson, Richard F.; Pawarod, Attaphol; Rowe, Jacob M.; Savani, Bipin N.; Savoie, Mary Lynn; Seo, Sachiko; Solh, Melhem; Tamari, Roni; Verdonck, Leo F.; Yared, Jean A.; Alyea, Edwin; Popat, Uday; Sobecks, Ronald; Scott, Bart L.; Nakamura, Ryotaro; Mesa, Ruben; Saber, Wael; Medicine, School of Medicine
    Allogeneic hematopoietic cell transplantation (HCT) is the only curative therapy for myelofibrosis (MF). In this large multicenter retrospective study, overall survival (OS) in MF patients treated with allogeneic HCT (551 patients) and without HCT (non-HCT) (1377 patients) was analyzed with Cox proportional hazards model. Survival analysis stratified by the Dynamic International Prognostic Scoring System (DIPSS) revealed that the first year of treatment arm assignment, due to upfront risk of transplant-related mortality (TRM), HCT was associated with inferior OS compared with non-HCT (non-HCT vs HCT: DIPSS intermediate 1 [Int-1]: hazard ratio [HR] = 0.26, P < .0001; DIPSS-Int-2 and higher: HR, 0.39, P < .0001). Similarly, in the DIPSS low-risk MF group, due to upfront TRM risk, OS was superior with non-HCT therapies compared with HCT in the first-year post treatment arm assignment (HR, 0.16, P = .006). However, after 1 year, OS was not significantly different (HR, 1.38, P = .451). Beyond 1 year of treatment arm assignment, an OS advantage with HCT therapy in Int-1 and higher DIPSS score patients was observed (non-HCT vs HCT: DIPSS-Int-1: HR, 2.64, P < .0001; DIPSS-Int-2 and higher: HR, 2.55, P < .0001). In conclusion, long-term OS advantage with HCT was observed for patients with Int-1 or higher risk MF, but at the cost of early TRM. The magnitude of OS benefit with HCT increased as DIPSS risk score increased and became apparent with longer follow-up.