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Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19
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JAMA Oncology | November 3, 2022 | Volume: 9 | Issue: 1 | Pages: 128
ImportanceCytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation.ObjectiveTo determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer.Design, Setting, and ParticipantsThis registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings.ExposuresImmunosuppression due to therapy; systemic anticancer therapy (IO or non-IO).Main Outcomes and MeasuresThe primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm.ResultsThe median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79).Conclusions and RelevanceThis cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm.Trial RegistrationClinicalTrials.gov Identifier: NCT04354701
Myeloproliferative Neoplasms, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology
Ali, Haris , Dunbar, Andrew , Elshoury, Amro, Gundabolu, Krishna , Jain, Tania , Jamieson, Catriona , Kaesberg, Paul, Madanat, Yazan F. , McMahon, Brandon , Nadiminti, Kalyan , Pardanani, Animesh , Rein, Lindsay , Salit, Rachel B. , Stein, Brady L. , Vachhani, Pankit , Wadleigh, Martha , Wall, Sarah , Ward, Dawn C., Bergman, Mary Anne, Hochstetler, Cindy L., Madanat, Yazan , Gerds, Aaron T. , Gotlib, Jason , Bose, Prithviraj , George, Tracy I. , Hexner, Elizabeth O. , Hobbs, Gabriela , Kuykendall, Andrew , Mohan, Sanjay , Oh, Stephen T. , Podoltsev, Nikolai , Talpaz, Moshe
Journal of the National Comprehensive Cancer Network | September 8, 2022 | Volume: 20 | Issue: 9 | Pages: 1033-1062
The classic Philadelphia chromosome–negative myeloproliferative neoplasms (MPN) consist of myelofibrosis, polycythemia vera, and essential thrombocythemia and are a heterogeneous group of clonal blood disorders characterized by an overproduction of blood cells. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for MPN were developed as a result of meetings convened by a multidisciplinary panel with expertise in MPN, with the goal of providing recommendations for the management of MPN in adults. The Guidelines include recommendations for the diagnostic workup, risk stratification, treatment, and supportive care strategies for the management of myelofibrosis, polycythemia vera, and essential thrombocythemia. Assessment of symptoms at baseline and monitoring of symptom status during the course of treatment is recommended for all patients. This article focuses on the recommendations as outlined in the NCCN Guidelines for the diagnosis of MPN and the risk stratification, management, and supportive care relevant to MF.
Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology
Thompson, John A. , Schneider, Bryan J. , Brahmer, Julie R. , Achufusi, Amaka, Armand, Philippe , Bhatia, Shailender , Chokshi, Saurin , Davies, Marianne, Elshoury, Amro, Gesthalter, Yaron , Kaffenberger, Benjamin H. , Li, Tianhong , Marr, Alissa , McGettigan, Suzanne , Medina, Theresa , Mohindra, Nisha , Oluwole, Olalekan O. , Patel, Sandip Pravin , Patil, Pradnya D. , Reddy, Sunil , Ryder, Mabel , Shofer, Scott , Sosman, Jeffrey A. , Lyons, Megan , Dwyer, Mary A., Hang, Lisa, Oluwole, Olalekan O , Kaffenberger, B , Ryder, Mabel , Berkenstock, Meghan , Budde, Lihua E. , Hegde, Aparna , Jain, Michael D. , Lechner, Melissa G , McPherson, Jordan P. , Medina, Theresa Michelle , Olszanski, Anthony J. , Santomasso, Bianca , Wang, Yinghong , Zaha, Vlad G
Journal of the National Comprehensive Cancer Network | April 7, 2022 | Volume: 20 | Issue: 4 | Pages: 387-405
The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions, consisting of medical and hematologic oncologists with expertise across a wide range of disease sites, and experts from the areas of dermatology, gastroenterology, endocrinology, neurooncology, nephrology, cardio-oncology, ophthalmology, pulmonary medicine, and oncology nursing. The content featured in this issue is an excerpt of the recommendations for managing toxicities related to CAR T-cell therapies and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to immune checkpoint inhibitors, visitNCCN.org.
Assessment of Regional Variability in COVID-19 Outcomes Among Patients With Cancer in the United States
Hawley, Jessica E. , Sun, Tianyi , Chism, David D. , Duma, Narjust , Fu, Julie , Gatson, Na Tosha , Mishra, Sanjay , Nguyen, Ryan H., Reid, Sonya , Serrano, Oscar K. , Singh, Sunny , Venepalli, Neeta K. , Bakouny, Ziad , Bilen, Mehmet Asım , Choueiri, Toni K. , Dawsey, Scott J. , Fecher, Leslie A. , Flora, Daniel , Friese, Christopher R. , Glover, Michael , Gonzalez, Cyndi J, Goyal, Sharad , Khan, Hina, Lewis, Mark A. , McKay, Rana R. , Messing, Ian , Puc, Matthew , Ravindranathan, Deepak , Rhodes, Terence D., Rivera, Andrea Verghese, Roller, John , Shah, Sumit , Shaya, Justin , Streckfuss, Mitrianna, Wulff‐Burchfield, Elizabeth , Xie, Zhuoer , Shah, Dimpy P. , French, Benjamin , Verma, Amit , Gartrell, Benjamin A. , Ohri, Nitin , Butt, Omar H. , Campian, Jian , Fiala, Mark A. , Monahan, Ryan, Bohachek, Pamela, Mundt, Daniel , Tadesse, Eyob, Lammers, Philip E. , Prete, Salvatore A. Del , Bär, Michael , Gulati, Anthony P., Lo, K. M. Steve, Stratton, Jamie , Weinstein, Paul L., García, Jorge A. , Nakayama, John , Gupta, Shilpa , Ahluwalia, Manmeet S. , Lemmon, Christopher A. , Nizam, Amanda , Hoppenot, Claire , Bouchard, Gabrielle, Busser, Fiona, Connors, Jean M. , Curran, Catherine , Demetri, George D., Kelleher, Kaitlin M. , Shaw, Grace, Allen, Eli Van, Nuzzo, Pier Vitale , Zon, Rebecca L. , Zhang, Tian , Leighton, John, Grivas, Petros , Lynch, Ryan C. , Schweizer, Michael T. , Vinayak, Shaveta , Wagner, Michael J. , Clément, Jessica , Daher, Ahmad , Dailey, Mark, Jayaraj, Asha, Hsu, Emily , Menendez, Alvaro G. , Rathmann, Joerg, Accordino, Melissa , Alexander, Mariam P., Mushtaq, Sarah, Bernicker, Eric , Deeken, John F. , Shafer, Danielle , Gill, David , Low, Clarke A., Mashru, Sandeep H., Mansoor, Abdul-Hai, Zaren, Howard A. , Smith, Stephanie J., Akhtari, Mojtaba, Lau, Eric , Reeves, Mark E. , Elms, Destry, Altman, Jessica K. , Gurley, Michael, Mulcahy, Mary F. , Kulkarni, Amit , Shah, Surbhi , Rosovsky, Rachel , Reynolds, Kerry L. , Bardia, Aditya , Gainor, Justin F. , Zubiri, Leyre , Bonnen, Mark , Mahadevan, Daruka , Salazar, Mary, Faller, Bryan A. , Ajmera, Archana , Brouha, Sharon S. , Cabal, Angelo , Kligerman, Seth , Weissmann, Lisa B., Jani, Chinmay , Thomson, Carey C. , Knoble, Jeanna, Glace, Mary Grace, Stauffer, Karen, Zacks, Rosemary, Blau, Sibel , Menon, Harry, Rovito, Marc A., Elshoury, Amro, Misdary, Christian, Shah, Mansi , Mahmood, Sana , Mico, Vasil, Logan, Barbara, Mandapakala, Chaitanya, Cabebe, Elwyn C., Jha, Alokkumar , Schapira, Lidia , Wu, Julie , Subbiah, Suki , Lopes, Gilberto , Revankar, Sanjay G. , Addison, Daniel , Chen, James L. , Karivedu, Vidhya , Lustberg, Maryam B. , Wall, Sarah , Williams, Nicole , Kasi, Anup , Edwin, Natasha, Smits, Melissa, Owenby, Susie, Doroshow, Deborah B. , Galsky, Matthew D. , Zhu, Huili , Sueyoshi, Mark, Riess, Jonathan W. , Patel, Kanishka G. , Rubinstein, Samuel M. , Ahmad, Syed A. , Grover, Punita , Kharofa, Jordan , Marcum, Michelle, Park, Cathleen, Geiger, Christoper L., Bishnoi, Rohit , Russ, Atlantis Dawn, Rho, Young Soo , Feldman, Lawrence , Hoskins, Kent , Gantt, Gerald, Liu, Li , Khan, Mahir, Nguyen, Ryan H., Schwartz, Candice, Mavromatis, Blanche H., Bijjula, Ragneel R., Cheng, Alex , Duda, Stephany N. , Enriquez, Kyle T. , Gillaspie, Erin A. , Hennessy, Cassandra , Johnson, Douglas B. , Slosky, David, Solórzano, Carmen C. , Vega-Luna, Karen, Kennecke, Hagen F. , Schroeder, Brett A., Carducci, Theresa M., Goldsmith, Karen J., Loon, Susan Van, Topaloĝlu, Ümit , Alimohamed, Saif, Rice, Robert, Cabalona, Wilhelmina D., Pilar, Christine, Peddi, Prakash , Rosen, L, McCollough, Briana Barrow, LoRusso, Patricia , Masters, Tyler, Choueiri, Toni K , Bakouny, Ziad , Hawley, Jessica E , Mishra, Sanjay , Wu, Julie T , Xie, Zhuoer , Zubiri, Leyre , Gatson, Na Tosha N , Fiala, Mark A , Ahluwalia, Manmeet S , Lustberg, Maryam , Nguyen, Ryan H., Bashir, Babar , Caimi, Paolo F. , Hálfdánarson, Þorvarður R. , Hershman, Dawn L. , Labaki, Chris , Pennell, Nathan A , Schwartz, Gary K. , Thompson, Michael A. , Yu, Peter Paul , Warner, Jeremy L. , Hwang, Clara , Halmos, Balázs , Goel, Sanjay , Sica, Roberto Alejandro , Thakkar, Astha , Stockerl‐Goldstein, Keith , Henderson, Jeffrey P. , Zhou, Alice Y. , Panagiotou, Orestis A. , Egan, Pamela , Farmakiotis, Dimitrios , Olszewski, Adam J. , Loaiza‐Bonilla, Arturo , Bar, Michael H., Rose, Suzanne J. , Barnholtz‐Sloan, Jill S. , Li, Ang , Giordano, Antonio , Nohria, Anju , Schmidt, Andrew , Xu, Vincent Eric , Halabi, Susan , Lyman, Gary H , Graber, Jerome J. , Khaki, Ali Raza , Loggers, Elizabeth T , Nakasone, Elizabeth S. , Tachiki, Lisa , Yeh, Albert C. , Huynh‐Le, Minh‐Phuong , Rosenstein, Lori J. , Dailey, Mark, Elias, Rawad , Gadgeel, Shirish M. , Bhutani, Divaya , Reuben, Daniel Y. , Alexander, Mariam, Nagaraj, Gayathri , Berg, Stephanie , Morgans, Alicia K. , Wehbe, Firas , Durbin, Eric B. , Nelson, Heather H. , Sachs, Zohar , Boland, Genevieve M. , Bekaii‐Saab, Tanios , Desai, Aakash , Mesa, Ruben A. , Ramirez, Amelie G , Shah, Pankil , Hsiao, Albert , Rink, Cameron L. , Joshi, Monika , Griffiths, Elizabeth A. , Jabbour, Salma K , McNair, Christopher M. , Kloecker, Goetz Hans , Stover, Daniel G. , Gatti-Mays, Margaret Elena , Jhawar, Sachin R. , Palmer, Joshua D. , Wotman, Michael T. , Fazio, Alyson, Huber, Kathryn E. , Wood, William A. , Jensen, Christopher Edward , Kumar, Vaibhav , Wise-Draper, Trisha Michel , Gulati, Shuchi , Latif, Tahir , Shaikh, Hira , Bowles, Daniel W. , Markham, Merry Jennifer , Shah, Chintan , Acoba, Jared David , Nguyen, Ryan H., Pasquinelli, Mary M. , Vikas, Praveen , Zaman, Qamar U., Davis, Elizabeth J. , Hausrath, Daniel J. , Hsu, Chih–Yuan , Li, Xuanyi , Rini, Brian I. , Shyr, Yu , Tucker, Matthew D. , Wang, Lucy Lu , Aboulafia, David M. , Schroeder, Brett , Hafez, Navid , Herbst, Roy S. , Stratton, Catherine
JAMA Network Open | January 4, 2022 | Volume: 5 | Issue: 1 | Pages: e2142046
Association of Convalescent Plasma Therapy With Survival in Patients With Hematologic Cancers and COVID-19
Shah, Pankil , Rubinstein, Samuel M. , Joyner, Michael J. , Choueiri, Toni K. , Flora, Daniel , Gulati, Anthony P., Koshkin, Vadim S. , Papadopoulos, Esperanza B. , Robilotti, Elizabeth , Su, Christopher , Wulff‐Burchfield, Elizabeth , Xie, Zhuoer , Yu, Peter Paul , Mishra, Sanjay , Senefeld, Jonathon W. , Shah, Dimpy P. , Verma, Amit , Gartrell, Benjamin A. , Ohri, Nitin , Butt, Omar H. , Campian, Jian , Fiala, Mark A. , Monahan, Ryan, Bohachek, Pamela, Mundt, Daniel , Streckfuss, Mitrianna, Tadesse, Eyob, Lammers, Philip E. , Revankar, Sanjay G. , Khan, Hina, Prete, Salvatore A. 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JAMA Oncology | August 19, 2021 | Volume: 7 | Issue: 8 | Pages: 1167
Myeloid/Lymphoid Neoplasms with Eosinophilia and TK Fusion Genes, Version 3.2021, NCCN Clinical Practice Guidelines in Oncology
Deininger, Michael W. , Dunbar, Andrew , Elshoury, Amro, Gojo, Ivana , Gundabolu, Krishna , Jain, Tania , Jamieson, Catriona , McMahon, Brandon , Oehler, Vivian G. , Pardanani, Animesh , Ranheim, Erik A. , Rein, Lindsay , Salit, Rachel B. , Snyder, David S., Stein, Brady L. , Vachhani, Pankit , Wadleigh, Martha , Walsh, Katherine, Ward, Dawn C., Bergman, Mary Anne, Sundar, Hema, Jain, Tania , Gerds, Aaron T. , Gotlib, Jason , Bose, Prithviraj , George, Tracy I. , Hexner, Elizabeth O. , Hobbs, Gabriela , Kuykendall, Andrew , Mohan, Sanjay , Oh, Stephen T. , Podoltsev, Nikolai , Talpaz, Moshe , Thota, Swapna
Journal of the National Comprehensive Cancer Network | September 4, 2020 | Volume: 18 | Issue: 9 | Pages: 1248-1269
Eosinophilic disorders and related syndromes represent a heterogeneous group of neoplastic and nonneoplastic conditions, characterized by more eosinophils in the peripheral blood, and may involve eosinophil-induced organ damage. In the WHO classification of myeloid and lymphoid neoplasms, eosinophilic disorders characterized by dysregulated tyrosine kinase (TK) fusion genes are recognized as a new category termed, myeloid/lymphoid neoplasms with eosinophilia and rearrangement of PDGFRA , PDGFRB or FGFR1 or with PCM1-JAK2 . In addition to these aforementioned TK fusion genes, rearrangements involving FLT3 and ABL1 genes have also been described. These new NCCN Guidelines include recommendations for the diagnosis, staging, and treatment of any one of the myeloid/lymphoid neoplasms with eosinophilia (MLN-Eo) and a TK fusion gene included in the 2017 WHO Classification, as well as MLN-Eo and a FLT3 or ABL1 rearrangement.