Browsing by Author "Stewart, Douglas"

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    ItemOpen Access
    Integrative analysis of clinicopathological features defines novel prognostic models for mantle cell lymphoma in the immunochemotherapy era: a report from The North American Mantle Cell Lymphoma Consortium
    (2023-12-16) Vose, Julie M.; Fu, Kai; Wang, Lu; Mansoor, Adnan; Stewart, Douglas; Cheng, Hongxia; Smith, Lynette; Yuan, Ji; Qureishi, Hina N.; Link, Brian K.; Cessna, Melissa H.; Barr, Paul M.; Kahl, Brad S.; Mckinney, Matthew S.; Khan, Nadia; Advani, Ranjana H.; Martin, Peter; Goy, Andre H.; Phillips, Tycel J.; Mehta, Amitkumar; Kamdar, Manali; Crump, Michael; Pro, Barbara; Flowers, Christopher R.; Jacobson, Caron A.; Smith, Sonali M.; Stephens, Deborah M.; Bachanova, Veronika; Jin, Zhaohui; Wu, Shishou; Hernandez-Ilizaliturri, Francisco; Torka, Pallawi; Anampa-Guzmán, Andrea; Kashef, Farshid; Li, Xing; Sharma, Sunandini; Greiner, Timothy C.; Armitage, James O.; Lunning, Matthew; Weisenburger, Dennis D.; Bociek, Robert G.; Iqbal, Javeed; Yu, Guohua; Bi, Chengfeng
    Abstract Background Patients with mantle cell lymphoma (MCL) exhibit a wide variation in clinical presentation and outcome. However, the commonly used prognostic models are outdated and inadequate to address the needs of the current multidisciplinary management of this disease. This study aims to investigate the clinical and pathological features of MCL in the immunochemotherapy era and improve the prognostic models for a more accurate prediction of patient outcomes. Methods The North American Mantle Cell Lymphoma Project is a multi-institutional collaboration of 23 institutions across North America to evaluate and refine prognosticators for front-line therapy. A total of 586 MCL cases diagnosed between 2000 and 2012 are included in this study. A comprehensive retrospective analysis was performed on the clinicopathological features, treatment approaches, and outcomes of these cases. The establishment of novel prognostic models was based on in-depth examination of baseline parameters, and subsequent validation in an independent cohort of MCL cases. Results In front-line strategies, the use of hematopoietic stem cell transplantation was the most significant parameter affecting outcomes, for both overall survival (OS, p < 0.0001) and progression-free survival (PFS, p < 0.0001). P53 positive expression was the most significant pathological parameter correlating with inferior outcomes (p < 0.0001 for OS and p = 0.0021 for PFS). Based on the baseline risk factor profile, we developed a set of prognostic models incorporating clinical, laboratory, and pathological parameters that are specifically tailored for various applications. These models, when tested in the validation cohort, exhibited strong predictive power for survival and showed a stratification resembling the training cohort. Conclusions The outcome of patients with MCL has markedly improved over the past two decades, and further enhancement is anticipated with the evolution of clinical management. The innovative prognostic models developed in this study would serve as a valuable tool to guide the selection of more suitable treatment strategies for patients with MCL.
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    ItemOpen Access
    Zoster prophylaxis after allogeneic hematopoietic cell transplantation using acyclovir/valacyclovir followed by vaccination
    (American Society of Hematology, 2016) Jamani, Kareem; MacDonald, Judy; Lavoie, Martin; Williamson, Tyler S.; Brown, Christopher B.; Chaudhry, Ahsan; Jimenez-Zepeda, Victor H.; Duggan, Peter; Tay, Jason; Stewart, Douglas; Daly, Andrew; Storek, Jan
    Varicella zoster virus (VZV) disease (usually cutaneous zoster) occurs frequently after hematopoietic cell transplantation (HCT), and postherpetic neuralgia (PHN) results in poor quality of life. The optimal prophylaxis of VZV disease/PHN has not been established. At our center, before 2008, VZV prophylaxis consisted of ∼1 year of post-HCT acyclovir/valacyclovir (“old strategy”), whereas post-2008 prophylaxis consisted of 2 years of acyclovir/valacyclovir followed by immunization using varicella vaccine (“new strategy”). We performed a retrospective study comparing the cumulative incidence of VZV disease and PHN among patients who completed the old strategy (n = 153) vs the new strategy (n = 125). Patients who completed the old strategy had a significantly higher cumulative incidence of VZV disease (33% vs 17% at 5 years, P ≤ .01) and PHN (8% vs 0% at 5 years, P = .02). In conclusion, VZV prophylaxis with 2 years of acyclovir/valacyclovir followed by vaccination appears to result in a low incidence of VZV disease and may eliminate PHN.