bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes with CD34 stem cell boost for poor graft function after allogeneic hematopoietic stem cell transplantation for hematologic malignancies: A systemic review and meta-analysis.
Authors: Shahzad Moazzam , Anwar Iqra , Siddiqui Raheel Sufian , Ahmed Tehniat Faraz , Majeed Mahrukh , Hassan Maha Awaiz , Ahmed Zahoor , Neupane Karun , Ali Tayyaba , Faisal Muhammad Salman , Naseem Masooma , Chaudhary Sibgha Gull , Balusu Ramesh , Ahmed Nausheen , Singh Anurag K , Abhyankar Sunil H. , McGuirk Joseph , Anwer Faiz , Mushtaq Muhammad Umair 
Published: June 2021

e19021 Background: Poor graft function (PGF) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation (allo-HCT) characterized by severe multilineage cytopenia in the absence of mixed donor chimerism, relapse, or severe graft-vs-host disease (GVHD). We present a systemic review and meta-analysis aimed to assess the outcomes with stem cell boost (SCB) for PGF in adult allo-HCT patients. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, 752 articles were screened from 4 databases (PubMed, Embase, Cochrane, and Clinical trials.gov) using MeSH terms and keywords for “hematological malignancies”, “hematopoietic stem cell transplantation”, “CD34 antigen(s)” and “treatment outcome(s)” from the date of inception to Jan 2021. After excluding review, duplicate and non-relevant articles, we included 8 studies (1 prospective, 7 retrospective) reporting hematologic complete/overall response rate (CR/ORR), GVHD and overall survival (OS) after SCB for PGF after Allo-HSCT. Quality evaluation was done using the NIH quality assessment tool. Pooled analysis was done using the ‘meta’ package (Schwarzer et al, R programming language) and proportions with 95% confidence intervals (CI) were computed. Inter-study variance was calculated using Der Simonian-Laird Estimator. Results: We identified 217 patients who received SCB for PGF after allo-HCT. Median age, time since transplant and SCB dose were 48 (37-54) years, 133 (113-450) days and 3.43 (1.7-4.9) million CD34 cells/kg respectively. CR and ORR were 71% (95%CI 0.63-0.77, I216%) and 80% (95%CI 0.74-0.85, I20%) respectively. After median follow up of 41.5 (5-77) months, actuarial survival rate (ASR) was 54% (95%CI 0.48-0.61, I20%). OS was reported from 80% (1y) to 40% (9y) Acute and chronic GVHD incidence after SCB was 17% (95% CI 0.12-0.23, I2=0%) and 17% (95% CI 0.08-0.32, I2=72%, n=197) respectively, and 25% (95% CI 0.14-0.39, I2=63%, n=163) deaths were due to relapse (Table). Conclusions: CD34 SCB improves outcomes after PGF after allo-HSCT with acceptable toxicity profile. However, current literature lacks high-quality randomized evidence and there remains an unmet need for prospective studies to address optimal dosing and manipulation of SCB. Outcomes with SCB for PGF after allo-HCT (n=217).[Table: see text]
Impact of clostridiodes difficile infection on acute graft-versus-host disease in allogenic transplant patients.
Authors: Lingamaneni Prasanth , Katiyar Vatsala , Kumar Rohit , Elsebaie Maha A.T. , Mann Hashim , Rodriguez Pierre , Zia Maryam 
Published: June 2021

e19027 Background: Clostridiodes difficile infection (CDI) is reported to occur up to 9-fold higher in allogenic hematopoietic stem cell transplant (HSCT) recipients compared to the general population of hospitalized patients. This is attributed to disruption of gut microbiome by antibiotics, myeloablative regimens, neutropenia, prolonged hospitalization, and immunosuppressive regimens administered to prevent acute graft-versus-host disease (aGVHD). CDI by disruption of the intestinal microbiome may trigger gastrointestinal aGVHD. Previous studies from HSCT centers have reported conflicting data on the relationship between CDI and subsequent development of aGVHD. Methods: The Nationwide Readmissions Database was queried for admissions of adult allogenic HSCT patients between 2016 and 2018. Those with and without CDI during index admission were compared. Multivariable logistic regression was used to evaluate the primary outcome of risk of aGVHD in the index admission or within 100 days post-engraftment. Results: A total of 13518 allogenic HSCT patients were included in the study. Mean age was 52.4 years. 57.2% of patients were female. The most common underlying diagnoses were acute myeloid leukemia (38%), myelodysplastic syndrome (17%) and acute lymphoblastic leukemia (14%). 11.1% of the index admissions were complicated by CDI. Rates of aGVHD during the index admission or 100 days post-engraftment were similar between CDI and non-CDI groups: 13.8% vs. 12.1%, p=0.19 during index admission and 29.2% vs. 26.1%, p=0.09 during 100 days post-engraftment. Nonetheless, patients with CDI had longer length of hospital stay (34.6 vs 29.8 days, p<0.0001), higher hospitalization costs ($608K vs $506K USD) and greater rate of inpatient mortality (7.3% vs 4.6%, p<0.001). In the multivariate regression analysis, CDI during index admission was not associated with risk of development of aGVHD (Adjusted Odds Ratio 1.14, 95% Confidence Interval 0.87-1.48, p=0.34). Age and unrelated donor HSCT were predictive of risk of aGVHD. Conclusions: CDI during index admission was not predictive of aGVHD during the first 100 days post-allogenic HSCT. HSCT patients are frequency colonized with C.difficile. Diarrhea secondary to CDI may resemble gastrointestinal aGVHD. Therefore, overdiagnosis of CDI in this population is a concern. Antimicrobial stewardship and use of clinical decision support tools have been advocated recently to decrease testing of HSCT patients with C.difficile colonization. Multivariable analysis of risk factors of aGVHD.[Table: see text]
Analyzing treatment patterns and time to the next treatment in chronic lymphocytic leukemia real-world data using automated temporal phenotyping.
Authors: Lee Kyeryoung , Liu Zongzhi , Ma Meng , Mai Yun , Gilman Christopher , Li Minghao , Zhang Mingwei , Mullaney Tommy , Pan Qi , Chen Rong , Schadt Eric , Wang Xiaoyan 
Published: June 2021

e19512 Background: Targeted therapy is an important treatment for chronic lymphocytic leukemia (CLL). However, optimal strategies for deploying small molecule inhibitors or antibody therapies in the real world are not well understood, largely due to a lack of outcomes data. We implemented a novel temporal phenotyping algorithm pipeline to derive lines of therapy (LOT) and disease progression in CLL patients. Here, the CLL treatment pattern and time to the next treatment (TTNT) were analyzed in real-world data (RWD) using patient electronic health records. Methods: We identified a CLL cohort with LOT from the Mount Sinai Data Warehouse (2003-2020). Each LOT consisted of either a single agent or combinations defined by NCCN CLL guidelines. We developed a natural language processing (NLP)-based temporal phenotyping approach to automatically identify the number of lines and therapeutic regimens. The sequence of treatment and time interval for each patient were derived from the systematic treatment data. Time to event analysis and multivariate (i.e., age, gender, race, other treatment patterns) Cox proportional hazard (CoxPH) models were used to analyze the patterns and predictors of TTNT. Results: Four hundred eleven CLL patients received 1 to 7 LOTs. Ibrutinib was the predominant 1st LOT (40.8% of patients) followed by anti-CD20-based antibody therapies and chemotherapy in 30.6 and 19.2% of patients, respectively, followed by Acalabrutinib, Venetoclax, and Idelalisib in 3.4, 2.7, and 0.7% of patients, respectively (Table 1). The 2nd to 5th LOT showed the same or similar trends. We next analyzed the TTNT in the 1st line of each therapeutic class. Acalabrutinib resulted in a longer median TTNT than Ibrutinib. Both Acalabrutinib and Ibrutinib showed longer TTNT compared to Venetoclax (median TTNTs were 742 and 598 vs. 373 days: HR = 0.23, p=0.015 and HR = 0.48, p=0.03, respectively). In addition, patients with age equal to or older than 65 showed longer TNNT (HR=0.16, p=0.016). Conclusions: Our result shows the potential of RWD usage in clinical decision making as real-world evidence reported here is consistent with results derived from clinical trial data. Linking this study to genetic data and other covariates affecting treatment outcomes may provide additional insights into the optimal sequences of the targeted therapies in CLL. Table 1: Therapeutic class and patient numbers (%) in each line.[Table: see text]
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) as front-line therapy for Hodgkins lymphoma in Hispanic patients: A single center experience from Texas-Mexico Border.
Authors: Gaur Sumit , Philipovskiy Alexander , Dwivedi Alok Kumar , Eiring Ana , Onyedika Umeanaeto , Orazi Attilio 
Published: June 2021

e19514 Background: Population-based studies in Hodgkin Lymphoma (HL) have shown reduced survival in patients of Hispanic ethnicity as compared with non-Hispanic Whites. ABVD is the most commonly used regimen for HL in the United States. We retrospectively reviewed the charts of Hispanic patients with HL treated at a single institution located along the Texas-Mexico border. Methods: We performed a chart review of Hispanic patients with HL treated at our institution over an 8 year period. Prognostic (Stage, International Prognostic Score) and predictive (results of interim and end of therapy PET scan) factors were recorded. Relative dose intensity (RDI: fraction of drug dose administered to the standard dose) of each chemotherapy drug was calculated.Treatment delays and their causes were recorded. Quantitative variables were described using median, inter-quartile range, minimum and maximum observations. Categorical variables were described using frequency and proportions. Kaplan – Meier curves were used to show relapse-free survival. Results: Base line characteristics are shown in table. A total of 24 patients were treated in the time frame of whom 45% were dependent on charity care. All were treated with ABVD or an ABVD-like regimen. After a median follow-up of 43 months, relapse rate for the entire cohort was 45.8%. ( 33.3% in early stage and 53.3% in advanced stage disease). Of the patients who relapsed 45% were unable to receive a stem cell transplant based salvage therapy. The RDI for each chemotherapy drug in ABVD was as follows: Doxorubicin (98.8%), Bleomycin (82.1%), vinblastine (97.9%) and dacarbazine (100%). The mean and median delay in completing chemotherapy was 9.9 and 5.5 days respectively (range 0-56). Conclusions: HL patients of Hispanic ethnicity have a high relapse rate with ABVD despite optimal delivery of the regimen. As medically underserved minority patients face significant barriers in accessing stem cell rescue based salvage treatments, decreasing the relapse rate with upfront therapy can help in addressing the disparity seen in survival. Non ABVD regimens shown to have a higher upfront remission rate like escalated dose BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) or A-AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine) should be studied in these patients.[Table: see text]
Imaging determinants of early progression in relapsed and refractory Hodgkin and diffuse large B cell lymphoma.
Authors: Bajpai Surabhi , Sharma Manish , Narang Shweta , Mankala Ravikanth , Lalchandani Usha , Narang Jayant , Jarecha Rudresh , Bohnsack Oliver 
Published: June 2021

e19522 Background: Diffuse Large B-cell Lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma with over 18,000 new cases diagnosed each year in the United States and approximately 7-8 cases per 100.000 people globally. Hodgkin’s Lymphoma (HL) is less common accounting for approximately 9,000 new cases each year. However, their imaging manifestations overlap; with both the diseases demonstrating extensive lymph nodal and extra-nodal involvement along with intense uptake on 18FDG-PET. Novel targeted therapies have been developed to improve survival in patients with DLBCL and HL. The purpose of this study analysis was to determine if there was a correlation between the baseline tumor burden and early tumor progression based on imaging. Methods: This retrospective study involved the analysis of baseline imaging data (CT, MRI and PET) of 469 patients enrolled in multiple phase II/III clinical trials involving a diagnosis of DLBCL and HL. Image analysis was performed utilizing the IWG criteria Lugano 2014 modification. The staging of the baseline disease burden was performed as per the Revised Staging System for Primary Nodal Lymphomas. In addition to the staging, the sum of the product of perpendicular diameters of all target lesions (SPD), and spleen size at baseline were recorded. The time point of disease progression was also captured in this analysis for each patient. These baseline imaging parameters were compared among patients with early progression (≤6 months following onset of therapy). Results: Out of the 469 patients, 61.4% of patients (n = 288/469) demonstrated disease progression during treatment and/or follow up phase of the trial. In this cohort, 64.5% (n = 186/288) of patients showed early progression. Patients with advanced stage disease at baseline (Stage II bulky, III and IV) showed a higher rate of early progression compared to those with limited baseline disease burden (Stage I and II) (47.1% vs 32.9%). The occurrence of early progression was similar in patients with normal spleen size at baseline compared to those with an enlarged spleen at baseline (39.3% vs 41%). There was a trend towards higher baseline SPD in patients with early progression (3204mm2, +12.5%) and late progression (3185mm2, +12%) compared to patients who did not demonstrate progression during the trial phase (2804mm2, p = 0.23-0.45). Conclusions: Baseline disease staging is an important determinant of early progression in patients with DLBCL and HL. Baseline tumor burden is potentially a predictive marker of disease progression. Therefore, precise staging along with accurate recording of baseline tumor burden have important prognostic and subsequent therapeutic strategy implications for prospective decision making in the era of precision medicine. Further prospective studies may be needed to validate our results.
Outcomes in peripheral T-cell lymphomas: An analysis of patients treated at a single academic institution.
Authors: Costa Philippos Apolinario , Ocejo Gallegos Jesus Antonio , Pongas Georgios 
Published: June 2021

e19524 Background: T-cell lymphomas are a heterogeneous group of lymphomas, including the cutaneous T cell lymphoma (CTCL) and the peripheral T cell lymphomas (PTCL). Regarding the PTCL, it’s a heterogeneous group including approximately 23 different diseases with the peripheral T-cell lymphoma not otherwise specified (PTCL NOS), angioimmunoblastic lymphoma (AITL), and anaplastic large cell lymphoma (ALCL) being the most frequent subtypes. In contrast with the B cell lymphomas, most of the PTCL have a worse prognosis. We aim in our study to quantify the prognosis in each of the most frequent subtypes of PTCL. Methods: We analyzed patients with either PTCL NOS, AITL, or ALCL treated at Sylvester Comprehensive Cancer Center between 2010 and 2020. We calculated overall survival (OS) using the Kaplan-Meier method with Log-Rank Test to estimate the 95% confidence interval. Results: 98 patients belonged to 1 of the 3 major T-cell lymphoma subtypes: 43 to PTCL NOS, 33 to AITL, and 20 to ALCL, being 7 ALK-positive and 13 ALK-negative. Mean age in PTCL NOS, AITL and ALCL was 56 years (ranging from 8-88), 62 (8-89), and 52 (1-79), respectively. In PTCL NOS, AITL and ALCL respectively, 21 (46%), 15 (45%) and 7 (35%) of patients were female. The three-year and five-year overall survival was 62% (95% CI 42-82) and 30% (95% CI 6-54%) in PTCL NOS, 64% (95% CI 44-84) and 42% (95% CI 4-78%) in AITL, 75 (95% CI 51-99) and 67% (95% CI 33-100) in ALK-negative ALCL. There were no reported deaths in ALK-positive ALCL. The mean survival was lowest in PTCL NOS (p = 0.02), being 3,6 years, while AITL it is 5.2 and in ALCL it is 8.4. Conclusions: Amongst the three major subtypes of PTCL, PTCL NOS have the worse prognosis. Future research is needed to develop a risk stratification tool in each subtype.
Prognostic value of early imaging following CAR T-cell therapy in DLBCL.
Authors: Bajwa Amneet , Huang Ying , Li Rui , Denlinger Nathan , Brammer Jonathan Edward , Saad Ayman A. , Jaglowski Samantha , Kittai Adam 
Published: June 2021

e19559 Background: Chimeric antigen receptor T-cell (CART) therapies lead to durable disease control in patients (pts) with relapsed/refractory (R/R) Diffuse Large B-cell Lymphoma (DLBCL). We assessed the prognostic value of response on first staging scan, and whether pts with progression of disease (PD) convert to a response on second scan. Methods: We conducted a retrospective analysis of pts with R/R DLBCL treated with CART at our institute. Baseline characteristics were assessed at apheresis. We included staging scans (CT, PET-CT and MRI) that occurred up to 6 months (mos) after CART infusion. Responses were determined via the Lugano 2014 criteria. Overall survival (OS) was calculated from first scan to last follow-up. Kaplan Meier method and Cox model were used to correlate first scan result with OS. Results: Of the 118 pts who received CART, 111 pts had evaluable staging scans (7 passed prior to first scan). Of the 111 pts, median age was 61 years (range, 23-84), and median number of prior therapies was 3 (range, 1-7). 61 pts received tisagenlecleucel, and 50 pts received axicabtagene ciloleucel. 22% of pts had MYC rearrangement by FISH. The majority of pts were stage 3/4 (91%), with an IPI score ≥2 (82%). 32%, 66% and 2% of pts had a CT, PET-CT or MRI as their first scan respectively. After a median follow-up of 16.2 mos, median OS from first scan was not reached (NR) (95% CI, 17-NR). 37%, 5%, 32%, 25% of pts had PD, SD, PR, and CR on first scan respectively. Median time to first scan was 59 days (range, 13-115). Median OS for pts who had PD was 3 mos (95% CI 2-8), and the median OS for those who attained SD, PR or CR was NR (95% CI NR-NR). Accounting for statistically important factors on multivariate analysis, PD on first scan was an independent predictor of OS (p<.001, HR 10.1 (95% CI 4.7-22)). We observed no evidence that pts with PD on first scan convert to a response on second scan without intervention. 26 of 41 pts who had PD did not start new treatment, 17 passed without follow-up scan, 1 is in follow-up, and 8 continued to show PD on subsequent scans. Conclusions: PD on first staging scan is a strong prognostic marker for survival for pts with R/R DLBCL who receive CART. There is no evidence to suggest conversion to a response will occur for patients who have PD. Performing staging scans at an earlier time-point has value, allowing for earlier treatment changes and goals of care conversations in this pt population.[Table: see text]
Hypercalcemia as a predictor of adverse treatment outcomes in DLBCL during chemotherapy: A national inpatient database study.
Authors: Kumi Dennis Danso , Shrivastava Trilok , Elsebaie Maha A.T. , laswi hisham , Ahuja Kriti , Batra Kunnal 
Published: June 2021

e19571 Background: Hypercalcemia occurs in up to 7% of NHL and up to 18% in diffuse large B-cell lymphoma (DLBCL) representing about 60% of cases. Thus far, there are only a few studies that have established the poor prognosis between hypercalcemia and outcomes in DLBCL. We sought to outline specific acute complications that can during admission for chemotherapy in patients with hypercalcemia. Methods: This is a retrospective analysis of hospital admission using the National Inpatient Sample database (2018), including 15,636 adult patients with DLBCL admitted for chemotherapy. We obtained descriptive data, conducted chi-square test, and stratified logistic regression to look for possible chemotherapy related acute medical complications & predictors of mortality in DLBCL with & without hypercalcemia. Study limitations included lack of long term follow up, variations in chemotherapy and possible under-reporting of test subjects. Results: The mean age among DLBCL patients with & without hypercalcemia were 65.41 and 58.52 years respectively and the mean length of stay were 6.56 and 4.98 days respectively. Patient’s race, type of insurance and Charlson’s comorbidity index were found to be significant predictors of mortality in patients with DLBCL admitted for chemotherapy. Among race, Hispanics & Asian or Pacific islanders were found to be at higher risk for mortality, while patients who had private insurance were found to be associated with higher mortality risk (p<0.01). Similarly, Native Americans (aOR 8.72, 1.93-39.34, p<0.01) and patients with Charlson comorbidity index of 4 or more were at higher risk of mortality (aOR 4.34, 2.30-8.18, p<0.01). In regard to acute medical complications, DLBCL patients with hypercalcemia were at higher risk for tumor lysis syndrome (TLS) (aOR 3.86, p<0.01), acute kidney injury (AKI) (aOR 4.28, p<0.01) and hyperuricemia (aOR 9.74, p<0.01). There was no significant association of hypercalcemia in DLBCL with hyperkalemia, fluid overload, ICU admission, mortality, total cost, or length of stay. Conclusions: Hypercalcemia is associated with higher adverse outcomes during chemotherapy treatment in patients with DLBCL including TLS, hyperuricemia, and AKI during chemotherapy admission. This confirms to the overall accession of poor outcomes as published by other studies.[Table: see text]