bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interventions to alleviate financial toxicity among patients with cancer: A systematic review.
Authors: Arastu Asad , Hamilton Andrew , Chen Emerson Yu-sheng 
Published: June 2021

e18841 Background: Financial toxicity (FT) has become a recognized side effect associated with cancer diagnosis and treatment; however, there is little data on what interventions have proven to be effective at mitigating the financial burden patients might face. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Met-Analysis (PRISMA) guidelines was conducted in MEDLINE, Embase, and PsycInfo. Broad terminology to capture FT and all possible interventions was used to identify articles published through June 25, 2020 in MEDLINE and July 31, 2020 in Embase and PsycInfo. We excluded systematic reviews, studies not conducted in the United States, with non-adult participants, or those that did not examine an intervention to directly alleviate FT. Two independent reviewers (AA and EYC) reviewed all abstracts to identify which articles met inclusion criteria. An inductive approach was used to thematically categorize unique intervention strategies. Results: A total of 1126 abstracts were identified from the initial search strategy, and 9 met final inclusion criteria. Across these studies, 12 distinct strategies were reported in 27 unique occurrences. They were mapped into four broad domains: 1) patient assistance programs (PAPs) through pharmaceutical company and/or charity sponsored programs, 2) financial navigators who provide counseling and community resources, 3) direct coverage through free medications or payments, and 4) indirect coverage for related services (e.g. transportation). Direct coverage was most commonly proposed, 15/27 (56%) of interventions, followed by PAPs 5/27 (18%), financial navigators 4/27 (15%), and indirect costs 3/27 (11%). These interventions led to outcomes including: cost savings to patients in 5/9 studies (56%), alleviated fears surrounding cost of treatment in 2/9 (22%), earlier medication fills in 1/9 (11%), and decreased anxiety on a self-reported Likert scale in 1/9 (11%). Conclusions: While potential solutions to FT from cancer care remain unclear, this systematic review demonstrates that particular implemented strategies have lessened patient expenses, improved therapy adherence, or helped patients live better. Additional resources could help equip providers and institutions on how to use existing infrastructure (PAPs) or how to deploy additional workforce to diminish FT.
The effect of different types of allogeneic hematopoietic stem cell transplantation donors in Philadelphia chromosome-positive acute lymphoblastic leukemia during tyrosine kinase inhibitors era: A systematic review and meta-analysis.
Authors: Ponvilawan Ben , Kungwankiattichai Smith , Charoenngam Nipith , Owattanapanich Weerapat 
Published: June 2021

e19022 Background: Matched donor (MD) allogeneic hematopoietic stem cell transplantation (allo-HSCT) is currently the preferred choice of treatment in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) who achieve complete remission. However, the unavailability of the appropriate donor remains a problem for a large group of patients. This systematic review and meta-analysis were conducted to investigate the effect of allo-HSCT from different types of the donor in Ph+ ALL patients who received tyrosine kinase inhibitors (TKIs). Methods: Studies from EMBASE and MEDLINE databases were identified from inception to December 2020 using search terms related to “Ph+ ALL” and “HSCT.” Eligible studies must be either randomized controlled trials or cohort studies with Ph+ ALL patients who received a TKI and allo-HSCT. The primary outcome of interest, consisting of overall survival (OS) or relapse-free survival (RFS), must be reported as the number of patients in each donor type. The Hantel-Maenszel method was implemented for combining effect estimates and associated 95% confidence interval (CI) from each. Results: Thirteen cohort studies were included for the meta-analysis. Haploidentical (HID)-HSCT for Ph+ ALL patients resulted in superior RFS than MD-HSCT with pooled odds ratio (OR) 1.64 (95%CI, 1.07–2.53; I2=0%) while had comparable OS (pooled OR 1.11 (95%CI, 0.74–1.69; I2=0%). Although HID-HSCT had significantly less relapse rate compared to the other group (pooled OR 0.53; 95%CI, 0.33–0.86; I2=0%), it also carried increased risks of graft-versus-host disease (GVHD) (pooled OR of acute GVHD rate 2.12; 95%CI, 1.05–4.31; I2=0% and chronic GVHD rate 1.63; 95%CI, 1.01–2.62; I2=0%). Matched sibling-HSCT, matched unrelated-HSCT, and cord blood-HSCT had the comparable OS and RFS to HID-HSCT. Conclusions: This systematic review and meta-analysis showed that HID-HSCT is as effective as MD-HSCT, and appears to be safe to implement in Ph+ ALL patients which could become useful in the case where there was no available donor.
Acute polymyositis presenting as chronic graft-versus-host disease: A systemic review.
Authors: Basit Abdul , Shahzad Moazzam , Chaudhary Sibgha Gull , Khalid Fatima , Ahmed Nausheen , Khurana Sharad , Ganguly Siddhartha , Abhyankar Sunil H. , McGuirk Joseph , Mushtaq Muhammad Umair 
Published: June 2021

e19025 Background: Chronic graft-versus-host disease (cGvHD) remains a significant complication of allogenic hematopoietic stem cell transplantation (allo-HSCT), with an estimated incidence of over 50%. Commonly targeted organs are skin, eyes, mouth, gastrointestinal tract, and liver. Muscular involvement and presentation as acute polymyositis (APM) remains a rare manifestation of cGvHD. We present a systemic review of APM associated with cGvHD to summarize current evidence regarding epidemiology, clinical presentation, diagnosis, treatment, and prognosis. Methods: A systemic review was conducting following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We screened 97 articles from 3 databases (PubMed, Embase, and Cochrane) using the MeSH terms and keywords for “Allogenic stem cell transplantation,” “Chronic graft-versus-host disease,” “Polymyositis” and “Myositis” from the date of inception to Jan 2021. After excluding duplicate, review and non-relevant articles, we included 36 studies (3 retrospective, others case series/reports) reporting APM associated with cGvHD after allo-HSCT. Results: We identified 72 patients, presented with APM associated with cGvHD after allo-HSCT. It involves cases of all ages, with male predominance. The onset of APM ranges as early as 100 days to 5 years, with a median range of 1.6 years post-allo-HSCT. Over half (59%) of patients had prior acute GvHD. Majority (85%) of cases presented with myalgia and progressive bilateral proximal muscle weakness with elevated Creatine phosphokinase (CPK) and/or Aldolase. Isolated presentation of APM without other manifestations of GvHD was rare, and concurrent skin involvement was present in 42% cases. Steroids remain the mainstay of treatment, achieving complete treatment response in up to 78% of cases. In some refractory cases, Rituximab has also been effective. Conclusions: APM can present as a sole manifestation of cGvHD with an estimated incidence of up to 3.4%. Diagnosis can be challenging as it can mimic idiopathic polymyositis. Radiologically targeted muscle biopsy showing characteristic myonecrosis remains the gold standard for diagnosis. Most (90%) cases respond to steroids and immunosuppression agents. Nevertheless, refractory cases remain challenging to treat and can cause significant morbidity and mortality. Characteristics of APM in 3 cohorts of allo-HSCT patients.[Table: see text]
Association of post-transplant outcomes with induction intensity in patients with acute myeloid leukemia.
Authors: Rebechi Melanie , Sahasrabudhe Kieran , Huang Ying , Elder Patrick , Blaser Bradley Wayne , Brammer Jonathan Edward , Choe Hannah Kyung , Efebera Yvonne Adeduni , Eisfeld Ann-Kathrin , Jaglowski Samantha , Larkin Karilyn T.M. , Long Meixiao , Mims Alice S. , Penza Sam L. , Saad Ayman A. , Vasu Sumithira , Wall Sarah Allison 
Published: June 2021

e19026 Background: The USFDA has recently approved several oral targeted therapies for the treatment of acute myeloid leukemia (AML). The relative survival impact of these agents vs standard induction chemotherapy in the frontline setting is unknown, especially in patients who undergo allogeneic hematopoietic cell transplant (HCT). Methods: This is a retrospective, single-institution study of 125 patients with AML diagnosed 2015-2020 who received HCT. Patients were included if induced with high intensity chemotherapy (HiC) or lower intensity targeted therapy (LITT). HiC was defined as cytarabine + anthracycline given on a “7+3” based schedule. LITT was defined as venetoclax, gilteritinib, enasidenib, or ivosidenib alone or combined with hypomethylating agent. Patients receiving liposomal cytarabine-daunorubicin were excluded. Outcomes of interest were overall survival (OS), non-relapse mortality (NRM), and cumulative incidence of relapse (CIR). Between-groups analysis was conducted comparing receipt of any HiC to LITT only. OS was analyzed by Kaplan-Meier method and compared using log-rank test; NRM and CIR was estimated through cumulative incidence function and compared by Fine-Gray test. Results: Of 125 HCT recipients, 108 received any HiC and 17 LITT only. Two patients received HiC after suboptimal response to LITT. Median age at HCT was 61 years, 48% were female, and 90% were in complete remission at HCT. Population characteristics and outcomes as well as between-groups comparison are presented in the table. LITT only group was older with longer time to HCT and exclusively received RIC. With median follow-up of 23 months, median OS had not been reached. There were no statistically significant differences in median OS or one-year NRM or CIR between groups. Conclusions: Despite differences in age, conditioning regimen, and time to HCT in patients receiving any HiC vs LITT only, we have shown similar OS, CIR, and NRM. Difference in age is in contrast to lack of difference in HCT-CI and KPS, but is partially explained by limited access to LITT for younger patients. Longer time to HCT among LITT only recipients represents a major opportunity for pre-HCT optimization of recipient health. Prospective study from time of diagnosis will be important to understanding the appropriate use of LITT in HCT-eligible patients.[Table: see text]
Updated overall survival of eltanexor for the treatment of patients with hypomethylating agent refractory myelodysplastic syndrome.
Authors: Lee Sangmin , Mohan Sanjay , Knupp Jessica , Chamoun Kamal , BAI Xiang , Ma Xiwen , Shah Jatin J. , Kauffman Michael , Shacham Sharon , Bhatnagar Bhavana 
Published: June 2021

e19037 Background: Patients (pts) with myelodysplastic syndrome (MDS) refractory to hypomethylating agents (HMAs) have limited therapeutic options and a dismal prognosis with a median overall survival (mOS) of 4-6 months. Eltanexor (ELTA) is a second-generation, oral, selective inhibitor of nuclear export (SINE) compound that showed anti-tumor activity and lower brain penetration compared to selinexor (SEL) in nonclinical models. It was hypothesized that ELTA could be dosed more frequently than SEL with a lower incidence of centrally mediated nausea. Early results from a phase 1/2 study of ELTA in pts with HMA refractory MDS showed anti-tumor activity with marrow complete response (mCR) and stable disease (SD); side effects were primarily low-grade, dose-dependent, and reversible (Lee et al. ASH 2019). In this abstract, we provide a subgroup analysis of the efficacy evaluable population with an update on mOS in the same population. Methods: This phase 1/2 study (NCT02649790) evaluated single-agent ELTA in pts with higher-risk MDS, ie, high-risk or intermediate-2 MDS by International Prognostic Scoring System (IPSS) and 5%-19% myeloblasts. Out of 20 pts enrolled, 15 pts were evaluable for efficacy and constitute the population studied in this analysis. Two doses of ELTA were evaluated: 10 mg (n=5) or 20 mg (n=15) every day for 5 days per week of a 28-day cycle. Results: As of 1 Feb 2021, the 15 pts evaluable for efficacy (median age 76 years; range 62-89) had a median of 2 prior treatment regimens (range 1-4); 93% had high/int-2 risk per IPSS. Of the 20 enrolled patients, 7 (35%) had mCR, and 5 (25%) had SD for a total disease control (mCR+SD) rate of 60%. Of the 15 pts evaluable for efficacy, 7 (47%) had mCR and 5 (33%) had SD. In the 10-mg cohort (n=5), all pts derived clinical benefit with 3 pts (60%) reaching mCR and 2 pts (40%) SD. In the 20-mg cohort (n=10), 4 pts (40%) had mCR and 3 (30%) had SD. Four pts had hematologic improvement (HI) and became transfusion independent for at least 8 weeks including 2 pts with tri-lineage HI. OS for pts who reached mCR (n=7) was significantly longer than for pts who did not reach mCR (n=8): median 11.86 vs 8.67 months (mo) (hazard ratio [HR]=0.27, p=0.05), and significantly longer than OS for pts with PD (n=3, mOS=3.15 mo, HR=0.23, p=0.04). Pts with disease control (n=12) had numerically longer mOS than pts with PD (9.86 vs 3.15 mo, HR=0.38, p=0.09). Pts with HI had a mOS of 10.58 months. Conclusions: Single-agent oral ELTA was active in pts with high-risk, HMA refractory MDS. Pts with mCR had significantly longer mOS than pts without mCR or with PD. Further evaluation of ELTA in MDS as a single agent and in combination with other agents is ongoing. Clinical trial information: NCT02649790.
Rate of seroconversion for routine vaccinations in patients with chronic lymphocytic leukemia on ibrutinib.
Authors: Ammad Ud Din Mohammad , Jamshed Saad 
Published: June 2021

e19509 Background: It is unclear whether Bruton tyrosine kinase inhibitors (BTKi) contribute to the humoral dysfunction in chronic lymphocytic leukemia. Methods: A literature search of PubMed, EmCare, and Google Scholar was performed on December 5, 2020. Five studies met inclusion criteria out of 249 studies per PRISMA guidelines (n = 244). Results: Pleyer et al. and Zent et al. showed an adequate recall humoral response to the shingle vaccine (41.5% and 75% seroconversion rate respectively), however, de novo response to hepatitis B vaccine was greatly reduced. Conflicting results were seen for the influenza vaccine as Sun et al. showed a significant increase in post-vaccination geometric mean titers for all three strains while only 7% of patients demonstrated seroconversion in the study by Douglas et al. None of the patients responded to the pneumococcal conjugate vaccine in a study by Andrick et al, though the results were not statistically significant (p = 0.029) (Table). Conclusions: Treatment with BTKi may not cause significant detrimental response to immunization but further studies are needed to elucidate longterm effects especially in patients with prior exposure to anti-CD20 antibodies.[Table: see text]
Treatment outcomes of stage IE intestinal extra-nodal marginal zone lymphoma: A National Cancer Database study.
Authors: Thomes Reggie M , Parsons Benjamin Marshall , Borgert Andrew J. , Frankki Susan M. 
Published: June 2021

e19530 Background: Extra-nodal marginal zone lymphoma is a rare, indolent non-Hodgkin lymphoma. Classically it involves the gastric mucosa and is associated with chronic infection, but it can also be found in the lower gastrointestinal (GI) tract. No standard therapy has been established for early stage disease in the small intestine, colon or rectum though multiple strategies have been employed. Little is known regarding the natural history and long-term outcomes of this disease when confined to the lower GI tract. We used the National Cancer Database (NCDB) to evaluate this patient population based upon treatment modality and disease site. Methods: Patients meeting the inclusion criteria were extracted from the 2017 Extra-Nodal Non-Hodgkin’s Lymphoma NCDB. Patients were grouped by primary treatment or observation status. Clinical and demographic factors were compared between the treatment groups via chi-square, Fisher’s exact and the Kruskal-Wallis tests. Comparison of Overall Survival (OS) between groups utilized either univariable log-rank comparison of the Kaplan-Meier estimator or multivariable Cox proportional hazards regression modelling, with patients censored at date of last contact. All analyses were performed with the SAS software suite, version 9.4. Results: 775 patients were identified with stage IE extra-nodal marginal zone lymphoma of the small intestine, colon or rectum with treatment and follow-up data. Prevalence increased over time. Median age at diagnosis was 65, with a ten-year overall survival for the entire cohort of 74.8% (69.8% - 79.0%). Location of disease was small intestine in 286 patients (36.9%), colon in 361 patients (46.6%) and rectum in 128 patients (16.5%). Ten-year overall survival was significantly worse for a small intestine primary site compared to colon and rectum primary sites (64.9% (55.6% - 72.6%) vs 81.5% (74.9% - 86.5%) and 80.9% (68.5% - 88.8%) respectively; p-value 0.013). Initial treatment was surgery in 361 patients (46.6%), radiation in 99 patients (12.8%), chemotherapy and/or immunotherapy in 120 patients (15.5%), and observation in 195 patients (25.1%). No significant differences in 5-year or 10-year survival were seen between treatment groups. Conclusions: Observation is a reasonable management strategy in patients with stage IE lower intestinal tract extra-nodal marginal zone lymphoma; survival is similar to those who received surgery, radiation or systemic therapy. Those with small intestine primary site had worse overall survival, irrespective of treatment modality, when compared to colon and rectum disease sites.
Same-day pegfilgrastim or pegfilgrastim-cbqv prophylaxis in miniCHOP chemotherapy based regimens for non-Hodgkin lymphoma.
Authors: Bartels Trace , McBride Ali , AlRawashdh Neda , Moore Logan , Persky Daniel O , Abraham Ivo 
Published: June 2021

e19542 Background: Non-Hodgkin’s lymphoma, specifically, diffuse large B-cell lymphoma (DLBCL) is most frequently diagnosed among older patients. The utilization of a reduced dose of cyclophosphamide, doxorubicin, vincristine, and prednisone (miniCHOP) chemotherapy-based regimen has an improved tolerance and toxicity profile in select patient populations. Prophylaxis with pegfilgrastim or its biosimilar pegfilgrastim-cbqv is administration on the same day of chemotherapy in all patients with MiniCHOP at The University of Arizona Cancer Center (UACC). We report here on the first study to address the safety and efficacy of same day pegfilgrastim administration in lymphoma patients receiving MiniCHOP. Methods: A retrospective, single center, cohort study was conducted at UACC between October 1, 2013 and October 2020 to evaluate lymphoma patients who were treated with miniR-CHOP and given pegfilgrastim or its biosimilar (pegfilgrastim-cbqv) for FN prophylaxis. The primary objective was to compare the incidence of FN across all cycles of chemotherapy and after the first cycle of chemotherapy in DLBCL patients on miniR-CHOP and provided with next-day versus same-day pegfilgrastim administration. Our secondary outcomes of interests were incidence of chemotherapy-induced neutropenia (CIN) grade 3/4; hospitalization; anti-biotics administration; and chemotherapy dose-reduction or delays. Results: A total of 100 cycles of miniR-CHOP were received, of these pegfilgrastim was administered on same-day of chemotherapy in 95 cycles and five cycles on the next-day of chemotherapy. Among all cycles the incidence of FN was 5.3% vs. 0.0 ( P= 1.00); CIN 3/4 was 10.5% vs. 0.0 ( P= 1.00); hospitalization was 10.5% vs. 20.0% ( P= 0.45), anti-biotics administration was 6.3% vs. 40.0% ( P= 0.05) and the chemotherapy dose delays or reductions was 16.8% vs. 0.0% ( P= 0.99). In the first cycle of chemotherapy, the incidence of FN was 14.3% vs. 0.0% ( P= 1.00), CIN 3/4 was 21.4% vs. 0.0 ( P= 1.00), hospitalization 28.6% vs. 25.0% ( P= 0.99), and the anti-biotics administration was 21.4% vs. 50.0% ( P= 0.53) for same-day vs. next-day study groups. Conclusions: In our analysis, we have shown that same-day pegfilgrastim or pegfilgrastim-cbqv was safe and effective in lymphoma patients receiving miniR-CHOP. There was no significant increase in FN or delayed engraftment in either group. Future prospective studies are warranted to address the safety and efficacy profile of same day pegfilgrastim or a pegfilgrastim biosimilars in elderly lymphoma patients.
Association of PET/CT response assessment prior to CAR T-cell infusion with outcomes after CAR T-cell therapy in aggressive B-cell lymphomas.
Authors: Nader Alexandra , Lee Hwan , Sellmyer Mark , Landsburg Daniel Jeffrey , Nasta Sunita , Gerson James , Svoboda Jakub , Barta Stefan K. , Weber Elizabeth , Schuster Stephen J. , Chong Elise A. 
Published: June 2021

e19568 Background: Anti-CD19 chimeric antigen receptor modified T-cell therapies (CAR-T) have expanded the treatment possibilities for many patients with relapsed/refractory (R/R) aggressive large B-cell lymphomas (B-NHL) but fails to achieve remissions in a considerable proportion of patients. In this study, we examined whether response to systemic therapy prior to CAR T-cell infusion is associated with outcome. Methods: We analyzed a retrospective dataset of R/R B-NHL patients (pts) treated with commercially available CAR-T at the University of Pennsylvania treated from April 2018 to August 2020. 18F-FDG PET/CT scans obtained directly prior to and after CAR-T therapy were re-evaluated for response by an independent radiologist using the Lugano 2014 criteria. Association between pre-therapy and post-therapy responses were examined using Fisher’s exact test. Results: 50 pts with aggressive R/R B-NHL were enrolled. 34 pts received tisagenlecleucel and 16 received axi-cel. Median age was 61 (range 29-82), and 27 pts (54%) were men. Most pts (n = 48, 96%) had ECOG performance status of 0-1, with a median number of 3 prior therapies (range 1-11). 14 (28%) of pts had LDH elevation at time of CAR T cell infusion. Median time from pre-therapy PET/CT to infusion was 47 days (range: 6-155). Median PFS was 3.4 months. Prior to CAR T cell infusion, responses were as follows: 12 complete response (CR), 9 partial response (PR), 8 stable disease (SD) and 21 progressive disease (PD). Post-therapy responses were: 20 CR, 5 PR, 2 SD, and 23 PD. 67% of pts with a CR pre-therapy had continued CR after CAR T-cell infusion, whereas 32% pf pts without a CR had a CR after infusion (p < 0.05). There was a trend toward CR/PR immediately prior to CAR T cell infusion being significantly associated with CR after CAR-T. We found that high metabolic tumor volume ( > 350cc vs ≤350cc) was associated with poorer PFS (log rank, p = 0.05). We did not find elevated LDH or use of bridging therapy to be associated with response to CAR-T. Conclusions: This is the largest report of lymphoma patients treated with CAR-T while in remission to date and suggests the importance of optimizing clinical response prior to CAR-T. Although patients in CR were excluded from the registrational trials, it is notable that patients in CR prior to CAR-T had a high rate of CR post CAR T cells despite the absence of active lymphoma on imaging. Longer follow-up is needed to confirm these early observations.