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  • 1
    In: Blood, American Society of Hematology, Vol. 99, No. 2 ( 2002-01-15), p. 450-456
    Abstract: Among patients with von Willebrand disease (VWD) who are unresponsive to desmopressin therapy, replacement with plasma-derived concentrates is the treatment of choice. Because prospective studies are lacking, such treatment has been largely empirical. A multicenter, prospective study has been conducted in 81 patients with VWD (15 patients with type 1, 34 with type 2, and 32 with type 3 disease) to investigate the efficacy of a high-purity factor VIII/von Willebrand factor (FVIII/VWF) concentrate for treatment of bleeding and surgical prophylaxis. Two preparations of the concentrate—one virally inactivated with solvent detergent, the other with an additional heat-treatment step—were evaluated. Pharmacokinetic parameters were similar for both preparations. Using pre-established dosages based on the results of pharmacokinetic studies, 53 patients were administered either preparation for the treatment of 87 bleeding episodes, and 39 patients were treated prophylactically for 71 surgical or invasive procedures. Sixty-five (74.7%) and 10 (11.5%) of the bleeding episodes were controlled with 1 or 2 infusions, respectively. Patients with severe type 3 VWD typically required more infusions and higher doses, at shorter time intervals, than did patients with generally milder types 1 and 2. Among patients undergoing surgical procedures, blood loss was lower than that predicted prospectively, and losses exceeding the predicted value did not correlate with the postinfusion skin bleeding time. In conclusion, the concentrate effectively stopped active bleeding and provided adequate hemostasis for surgical or invasive procedures, even in the absence of bleeding time correction.
    Type of Medium: Online Resource
    ISSN: 1528-0020 , 0006-4971
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2002
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  • 2
    In: Blood, American Society of Hematology, Vol. 114, No. 10 ( 2009-09-03), p. 2051-2059
    Abstract: Current treatment strategies for Hodgkin lymphoma result in excellent survival but often confer significant long-term toxicity. We designed ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide) to (1) enhance treatment efficacy by dose-dense drug delivery and (2) reduce risk of long-term sequelae by response-based reduction of cumulative chemotherapy. Efficient induction of early response by dose-dense drug delivery supported an early-response–adapted therapeutic paradigm. The 216 eligible patients were younger than 22 years with intermediate- or high-risk Hodgkin lymphoma. ABVE-PC was administered every 21 days. Rapid early responders (RERs) to 3 ABVE-PC cycles received 21 Gy radiation to involved regions; RER was documented in 63% of patients. Slow early responders received 2 additional ABVE-PC cycles before 21 Gy radiation. Five-year event-free-survival was 84%: 86% for the RER and 83% for the slow early responders (P = .85). Only 1% of patients had progressive disease. Five-year overall survival was 95%. With this regimen, cumulative doses of alkylators, anthracyclines, and epipodophyllotoxins are below thresholds usually associated with significant long-term toxicity. ABVE-PC is a dose-dense regimen that provides outstanding event-free survival/overall survival with short duration, early-response–adapted therapy. This trial was registered at www.clinicaltrials.gov as #NCT00005578.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 3
    In: Blood, American Society of Hematology, Vol. 118, No. 25 ( 2011-12-15), p. 6675-6682
    Abstract: Transfusions of RBCs stored for longer durations are associated with adverse effects in hospitalized patients. We prospectively studied 14 healthy human volunteers who donated standard leuko-reduced, double RBC units. One unit was autologously transfused “fresh” (3-7 days of storage), and the other “older” unit was transfused after 40 to 42 days of storage. Of the routine laboratory parameters measured at defined times surrounding transfusion, significant differences between fresh and older transfusions were only observed in iron parameters and markers of extravascular hemolysis. Compared with fresh RBCs, mean serum total bilirubin increased by 0.55 mg/dL at 4 hours after transfusion of older RBCs (P = .0003), without significant changes in haptoglobin or lactate dehydrogenase. In addition, only after the older transfusion, transferrin saturation increased progressively over 4 hours to a mean of 64%, and non–transferrin-bound iron appeared, reaching a mean of 3.2μM. The increased concentrations of non–transferrin-bound iron correlated with enhanced proliferation in vitro of a pathogenic strain of Escherichia coli (r = 0.94, P = .002). Therefore, circulating non–transferrin-bound iron derived from rapid clearance of transfused, older stored RBCs may enhance transfusion-related complications, such as infection. The trial was registered with www.clinicaltrials.gov as #NCT01319552.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2011
    detail.hit.zdb_id: 1468538-3
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  • 4
    In: Blood, American Society of Hematology, Vol. 140, No. 5 ( 2022-08-04), p. 419-437
    Abstract: The number of patients with primary cutaneous lymphoma (PCL) relative to other non-Hodgkin lymphomas (NHLs) is small and the number of subtypes large. Although clinical trial guidelines have been published for mycosis fungoides/Sézary syndrome, the most common type of PCL, none exist for the other PCLs. In addition, staging of the PCLs has been evolving based on new data on potential prognostic factors, diagnosis, and assessment methods of both skin and extracutaneous disease and a desire to align the latter with the Lugano guidelines for all NHLs. The International Society for Cutaneous Lymphomas (ISCL), the United States Cutaneous LymphomaConsortium (USCLC), and the Cutaneous Lymphoma Task Force of the European Organization for the Research and Treatment of Cancer (EORTC) now propose updated staging and guidelines for the study design, assessment, endpoints, and response criteria in clinical trials for all the PCLs in alignment with that of the Lugano guidelines. These recommendations provide standardized methodology that should facilitate planning and regulatory approval of new treatments for these lymphomas worldwide, encourage cooperative investigator-initiated trials, and help to assess the comparative efficacy of therapeutic agents tested across sites and studies.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
    detail.hit.zdb_id: 1468538-3
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  • 5
    In: Blood, American Society of Hematology, Vol. 116, No. 21 ( 2010-11-19), p. 662-662
    Abstract: Abstract 662 To compare the effects on iron metabolism of transfusion of packed red blood cells (RBCs) after prolonged (40-42 days) and short-term (3–7 days) storage, we prospectively studied 9 healthy adults. Each volunteer donated a standard, leukoreduced, double RBC unit by automated apheresis and was then transfused with the first autologous RBC unit after 3–7 days of storage and the second after 40–42 days of storage. Timed blood samples were obtained just before each transfusion and immediately, 1, 2, 4, 24, and 72-hours after transfusion. Plasma non-transferrin bound iron (NTBI) was quantified by an ultrafiltration assay, serum hepcidin determined by an immunoassay, and complete blood counts and other laboratory measures obtained by standard methods. For each analyte, differences after transfusion of the older and fresher RBCs were evaluated by 2-way ANOVA with a Bonferroni post-test. At 24 hours after transfusion, similar increases in mean hemoglobin concentration were found with the older (0.83 ± 0.54 (SD) g/dL) and fresher (0.74 ± 0.58 (SD) g/dL) units (p=0.30). At 4 hours after transfusion of older RBCs there was a significant, ~3-fold increase over baseline in mean serum iron (by 160 ± 99 mcg/dL with older vs. −7 ± 25 mcg/dL with fresher RBCs, p 〈 0.001), along with ~2-fold rise in mean total serum bilirubin (by 0.52 ± 0.37 mg/dL with older vs. −0.09 ± 0.18 mg/dL with fresher RBCs, p 〈 0.001). There were no significant differences in circulating lactate dehydrogenase or haptoglobin at any time. The significant increases in mean transferrin saturation (p 〈 0.001) and mean change in plasma NTBI (p 〈 0.001) seen after transfusions of older RBCs are shown in the accompanying Figure. After transfusion of fresher and older blood, mean serum hepcidin concentrations were not significantly different at any time and no significant differences were found in mean serum C-reactive protein (CRP) or interleukin (IL)-6 levels. Current FDA standards allow refrigerated RBC units to be stored for up to 42 days before transfusion based on the criteria that, on average, less than 25% of the transfused RBCs will be cleared from the circulation in the first 24 hours. In critically ill patients, observational studies identified increases in serious infections, multi-organ failure, and mortality associated with transfusion of older stored RBCs, but the underlying mechanisms have yet to be determined. In healthy volunteers, our results indicate that transfusions of RBCs stored for 3–7 days did not significantly increase serum iron or induce the appearance of plasma NTBI. In contrast, transfusion of RBCs stored for 40–42 days significantly increased serum iron and transferrin saturation and produced substantial amounts of plasma NTBI, in association with the apparently extravascular clearance of a subpopulation of the transfused RBCs. Plasma NTBI can promote bacterial growth and induce oxidative injury. The observed increases in plasma NTBI in healthy volunteers after transfusion of older stored RBCs produced no clinically-evident adverse effects. Nonetheless, in critically ill patients, increases in plasma NTBI may enhance the risk of sepsis, multi-organ failure, and death. Disclosures: Olbina: Intrinsic LifeSciences LLC: Employment. Westerman:Intrinsic Life Sciences: Employment, Membership on an entity's Board of Directors or advisory committees.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
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  • 6
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 620-620
    Abstract: Abstract 620 Classification of DLBCL into cell-of-origin (COO) subtypes based on gene expression profiles has well-established prognostic value. These subtypes, termed Germinal Center B cell (GCB) and Activated B cell (ABC) also have different genetic alterations and over-expression of different pathways that may serve as therapeutic targets. Thus, accurate classification is essential for analysis of clinical trial results and planning new trials using targeted agents. The gold standard for COO classification uses gene expression profiling (GEP) of snap frozen tissues, and a Bayesian predictor algorithm utilizing the expression levels of 14 key genes (G. Wright et al PNAS 2003). An immunohistochemistry (IHC) classification scheme by C. Hans et al (Blood 2004), based on 3 antibodies, is widely used as a substitute for GEP classification, however does not completely correlate with GEP. We recently described a qNPA assay (ArrayPlateR, High ThroughPut Genomics, Tucson, AZ) with excellent correlation between frozen and formalin fixed paraffin embedded (FFPE) tissues (R. Roberts et al, Lab Invest 2007). In this study, we investigated whether this technique could be used for accurate classification of COO using FFPE tissues. We expanded the previous gene probe repertoire of the DLBCL-ArrayPlateR assay to include the 14 genes (represented by 17 probe sets) most pertinent to COO classification. 52 cases of R-CHOP treated DLBCL that had undergone GEP using the Affymetrix U133 Plus 2.0 microarray and had matching FFPE blocks were analyzed with qNPA in duplicate. The genes included CD10, LRMP, CCND2, ITPKB, PIM1, IL16, IRF4, FUT8, BCL6, PTPN1, LM02, CD39, MYBL1, IGHM. Results were evaluated using the previously published algorithm with a leave-one-out cross validation scheme to classify cases into GCB or ABC subtypes. These results were compared to COO classification based on frozen tissue GEP profiles. All 14 genes in all 52 cases were successfully analyzed with no missing data points. For each case, a probability statistic was generated indicating the likelihood that the classification using qNPA was accurate. Of the 54 cases, 25 were GCB, 27 were ABC and 4 were unclassifiable by GEP. Of the GCB cases, 23/25 (92%) were classified correctly by qNPA with a confidence cut-off of 〉 0.9 and 25/25 (100%) classified correctly with a confidence cut-off of 〉 0.8. Of the ABC cases, 25/27 (93%) were correctly classified as ABC using qNPA with a confidence cut-off of 〉 0.9 and 27/27 (100%) classified correctly with a confidence cut-off of 〉 0.8. In summary, the qNPA technique accurately categorized DLBCL into GCB and ABC subtypes, as defined by GEP. There were no technical difficulties with any of the pathological materials although they were collected retrospectively from a variety of institutions and countries with different fixation methods. This approach represents a substantial improvement over previously published IHC methods and is applicable to FFPE tissues, therefore overcoming the need for snap frozen materials. This technically robust classification method has potential to have a significant impact on future DLBCL research and clinical trial development. Disclosures: Rimsza: High Throughput Genomics: HTG provided the assays at no charge to Dr. Rimsza's lab. Schwartz:High Throughput Genomics: Employment. Gascoyne:Roche Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 7
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 2087-2087
    Abstract: For patients with recurrent and refractory Hodgkin Disease (HD), the major risk after standard treatment with high-dose chemotherapy and autologous hematopoietic stem cell rescue (ASCR) is relapse. In the setting of allogeneic SCT, the graft-vs.-lymphoma effect is offset by high transplant-related mortality. The Children’s Oncology Group has therefore undertaken a study of immunotherapy to induce autologous graft-vs.-host disease (auto GVHD) in an effort to reduce the relapse rate without excessive morbidity and mortality. The objectives of part I of the study were to determine the toxicity and feasibility of inducing auto GVHD with cyclosporine, interferon-γ , and IL-2 after high-dose BEAM. Twenty-four patients with biopsy-confirmed recurrent/refractory HD were enrolled at 13 institutions. One patient was inevaluable because of a protocol violation. At initial diagnosis, 5 were stage IV, 8 stage III, 7 stage II, 1 stage I, and 3 unknown; 16 had B symptoms, and 15 had bulky disease. All patients had failed intensive multi-agent chemotherapy, and most had received prior radiation therapy. At relapse, 3 patients had B symptoms and 2 had bulky disease, and 8 had extranodal disease. All patients received full doses of the preparative regimen, with the expected reversible complications of febrile neutropenia, pancytopenia, nausea, vomiting, anorexia, mucositis, and electrolyte disturbances. In addition to fever, fatigue, and cytopenias, two patients developed pneumonitis after receiving immunotherapy, one of whom died of respiratory failure 6 wks after study entry. Of note, this patient received only 2 doses of IL-2 before developing pneumonitis. Bronchoalveolar lavage failed to demonstrate an etiology, but a culture obtained by open lung biopsy was positive for staphylococcus epidermidis. One patient developed a rash and one patient developed liver function abnormalities during the immunotherapy consistent with auto GVHD. Toxicities Toxicity RT/BEAM/ASCR Immunotherapy n = 16 n = 15 Febrile neutropenia 11 (69%) 4 (27%) Nausea/vomiting/anorexia 10 (63%) 3 (20%) Mucositis 7 (44%) 2 (13%) Metabolic/lab 8 12 Pneumonitis 0 2 (13%) Fever 0 2 (13%) Fatigue 0 2 (13%) Hypotension 1 (6%) 0 Blood was requested at weekly intervals during immunotherapy administration to test for autoreactivity in mixed lymphocyte cultures and by cytokine assays with autologous stimulator cells. The sample submission rate was 90%. In 11 of 14 patients, there was significant in vitro lymphocyte autoreactivity. We conclude that this immunotherapy regimen is tolerable and induces autoreactivity in a sufficient proportion of patients to warrant proceeding with part II of the study. Part II will test the efficacy of immunotherapy by randomizing patients with chemosensitive recurrent/refractory HD to receive immunotherapy or not after BEAM and ASCR.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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